The MCG Pediatric Podcast

Did you know that Obsessive-Compulsive Disorder (OCD) affects approximately 1 in 200 children, with symptoms often emerging between the ages of 7 and 12? As pediatricians, you're likely the first to encounter these patients, making early recognition and intervention critical for achieving optimal outcomes. In this episode, we'll provide you with the knowledge and tools needed to accurately diagnose and effectively manage OCD, laying the foundation for better long-term care. Dr. Theresa Fiagbe, a second-year Child Psychiatry Fellow, Dr. Dale Peeples, Associate Professor of Child Psychiatry, and Alisha Patel, Medical Student at the Medical College of Georgia, join forces to unpack the complexities of OCD in children and adolescents. Tune in as we: Explore key diagnostic criteria and the most effective screening tools for identifying OCD in pediatric patients Discuss evidence-based treatments such as Cognitive Behavioral Therapy (CBT) and SSRIs, and how to incorporate them into your practice Review common comorbid conditions, like anxiety and PANDAS, that can complicate diagnosis and treatment Examine the impact of OCD on school performance, social interactions, and family life Share practical guidance on managing long-term care to prevent relapse and ensure successful outcomes Whether you're encountering OCD symptoms in a patient for the first time or seeking to enhance your expertise, this episode will equip you with the essential tools to improve diagnosis and treatment. Special thanks to Dr. Yang for editing and Dr. Sarah Straka, and Dr. Baris Olten for peer reviewing this episode. CME Credit Available: Link Coming Soon! References: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing. Berman, L., & Flessner, C. A. (2014). Pediatric obsessive-compulsive disorder: Diagnostic and treatment issues. Journal of the American Academy of Child and Adolescent Psychiatry, 53(2), 123-131. https://doi.org/10.1016/j.jaac.2013.10.003 Clark, C. A., & Scharf, R. (2020). Cognitive-behavioral therapy for obsessive-compulsive disorder in children and adolescents: Current trends and future directions. Journal of the American Academy of Child and Adolescent Psychiatry, 59(9), 971-979. https://doi.org/10.1016/j.jaac.2020.05.007 Fahrion, S., & Goodwin, G. M. (2019). Pharmacological treatment of pediatric obsessive-compulsive disorder: SSRIs, clomipramine, and beyond. Current Psychiatry Reports, 21(8), 58-66. https://doi.org/10.1007/s11920-019-1040-3 Franklin, M. E., & March, J. S. (2015). Treatment of obsessive-compulsive disorder in children and adolescents. Pediatric Clinics of North America, 62(3), 529-545. https://doi.org/10.1016/j.pcl.2015.02.004 March, J. S., & Mulle, K. (2017). OCD in children and adolescents: A review of treatments and practical guidance. The Psychiatric Clinics of North America, 40(2), 199-208. https://doi.org/10.1016/j.psc.2017.01.002 Murphy, T. K., & Pincus, D. B. (2019). Pediatric obsessive-compulsive disorder: Diagnosis, treatment, and future directions. Current Opinion in Pediatrics, 31(4), 517-524. https://doi.org/10.1097/MOP.0000000000000801 PANDA Study Group. (2017). Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Journal of the American Academy of Child and Adolescent Psychiatry, 56(11), 933-940. https://doi.org/10.1016/j.jaac.2017.07.866 Peris, T. S., & Piacentini, J. (2021). Pediatric obsessive-compulsive disorder: Treatment strategies and challenges. Journal of Clinical Child and Adolescent Psychology, 50(1), 32-43. https://doi.org/10.1080/15374416.2020.1831504 Reaven, J. (2018). Screening for pediatric obsessive-compulsive disorder: Tools, guidelines, and challenges. Child and Adolescent Mental Health, 23(3), 133-139. https://doi.org/10.1111/camh.12267 Thienemann, M., & McGuire, L. (2019). Treating pediatric OCD with a focus on cognitive-behavioral therapy: Evidence and efficacy. Journal of Clinical Child and Adolescent Psychology, 48(4), 530-538. https://doi.org/10.1080/15374416.2019.1612851

Did you know that congenital cytomegalovirus (cCMV) is the most common congenital viral infection in newborns and a leading cause of non-genetic hearing loss? Despite its prevalence, awareness and screening for cCMV remain inconsistent across healthcare systems. In this episode, we dive into the critical importance of cCMV screening, early diagnosis, and intervention. Join our expert guests Dr. Ingrid Camelo and Dr. John Noel as they discuss: The impact of cCMV on neonatal and long-term health outcomes Best practices for screening and diagnostic methods The role of early intervention, including antiviral therapy How advocacy efforts are shaping the future of universal screening policies Tune in to stay informed on how pediatricians and healthcare providers can play a vital role in improving outcomes for infants affected by cCMV. Special thanks to Dr. James Grubbs for peer reviewing this episode. CME Credit (requires free sign up): Link Coming Soon! References:  American Academy of Pediatrics. A targeted approach for congenital cytomegalovirus. Available at: https://publications.aap.org/pediatrics/article/139/2/e20162128/60211/A-Targeted-Approach-for-Congenital-Cytomegalovirus. Accessed August 13, 2024. Chiopris G, Veronese P, Cusenza F, Procaccianti M, Perrone S, Daccò V, Colombo C, Esposito S. Congenital cytomegalovirus infection: update on diagnosis and treatment. Microorganisms. 2020 Oct 1;8(10):1516. doi: 10.3390/microorganisms8101516. PMID: 33019752; PMCID: PMC7599523. Gantt S. Newborn cytomegalovirus screening: is this the new standard? Curr Opin Otolaryngol Head Neck Surg. 2023 Dec 1;31(6):382-387. doi: 10.1097/MOO.0000000000000925. Epub 2023 Oct 11. PMID: 37820202. Minnesota Department of Health. Minnesota implements universal newborn screening for cytomegalovirus. Available at: https://www.health.state.mn.us/news/pressrel/2023/ccmv020823.html. Accessed August 13, 2024. National CMV Foundation. Advocacy: universal newborn CMV screening. Available at: https://www.nationalcmv.org/about-us/advocacy#:~:text=Minnesota%20was%20the%20first%20state%20to%20enact%20universal%20newborn%20CMV%20screening. Accessed August 13, 2024. New York State Department of Health. Newborn screening for cytomegalovirus. Available at: https://www.health.ny.gov/press/releases/2023/2023-09-29_newborn_screening.htm#:~:text=ALBANY%2C%20N.Y.,all%20babies%20for%20the%20virus. Accessed August 13, 2024. UpToDate. Congenital cytomegalovirus (CMV) infection: clinical features and diagnosis. Available at: https://www.uptodate.com/contents/congenital-cytomegalovirus-ccmv-infection-clinical-features-and-diagnosis?search=cmv%20screening&source=search_result&selectedTitle=1%7E28&usage_type=default&display_rank=1#H92269684. Accessed August 13, 2024. UpToDate. Congenital cytomegalovirus (CMV) infection: management and outcome. Available at: https://www.uptodate.com/contents/congenital-cytomegalovirus-ccmv-infection-management-and-outcome?search=congenital%20cmv&source=search_result&selectedTitle=2%7E66&usage_type=default&display_rank=2. Accessed August 13, 2024. UpToDate. Ganciclovir and valganciclovir: an overview. Available at: https://www.uptodate.com/contents/ganciclovir-and-valganciclovir-an-overview?search=ganciclovir&source=search_result&selectedTitle=2%7E80&usage_type=default&display_rank=1#H6. Accessed August 13, 2024. University of Texas Medical Branch. Neonatology manual: infectious diseases. Available at: https://www.utmb.edu/pedi_ed/NeonatologyManual/InfectiousDiseases/InfectiousDiseases3.html#:~:text=may%20be%20required.-,Cytomegalovirus,Clinical%20findings. Accessed August 13, 2024. National Center for Biotechnology Information. Cytomegalovirus (CMV) infection. Available at: https://www.ncbi.nlm.nih.gov/books/NBK541003/. Accessed August 13, 2024.                                                                                                             

The adolescent population is experiencing increasing pressure to take part in sexual activity. It is part of our role as pediatricians to counsel our patients appropriately & thoroughly through their sexual & reproductive health. Dr. Shreeti Kapoor, a general pediatrician, joins Pediatric Resident Dani Watson & MS3 Irielle Duncan to discuss contraception options & how to have those conversations with adolescent patients. Specifically, they will: Review the efficacy, mechanism of action, potential adverse effects, and benefits of various contraceptive options, including abstinence, barrier methods, combination hormonal contraceptives, Depo Provera, and LARCs.  Discuss how to obtain relevant medical and sexual history to help in choosing an appropriate contraceptive for an adolescent patient.  Identify potential barriers or considerations that are specific for adolescent patients when discussing contraceptives.  Discuss options for emergency contraception & their mechanisms of action.  Special thanks to Drs. Rebecca Yang & Danielle Rosema for peer reviewing this episode. CME Credit (requires free sign up): Link Coming Soon! References:  https://www.aafp.org/pubs/afp/issues/2003/0401/p1571.html https://www.cdc.gov/nchs/products/databriefs/db366.htm#:~:text=By%20age%2015%2C%2021%25%20of,had%20ever%20had%20sexual%20intercourse. https://www.plannedparenthood.org/learn/birth-control/withdrawal-pull-out-method/how-effective-is-withdrawal-method-pulling-out#:~:text=What%20we%20do%20know%20is,or%20not%20you%27re%20ovulating. https://www.acog.org/womens-health/faqs/barrier-methods-of-birth-control-spermicide-condom-sponge-diaphragm-and-cervical-cap https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/11/long-acting-reversible-contraception-implants-and-intrauterine-devices https://www.acog.org/womens-health/faqs/combined-hormonal-birth-control-pill-patch-ring https://www.acog.org/womens-health/faqs/progestin-only-hormonal-birth-control-pill-and-injection https://www.aafp.org/pubs/afp/issues/1998/0801/p522.html https://www.acog.org/womens-health/infographics/effectiveness-of-birth-control-methods      

Language delays are one of the most common concerns brought up in pediatric well visits. Dr. Jennifer Poon, a pediatric specialist in Development and Behavior, joins Dr. Sarah Straka and medical student Alisha Patel to discuss how to recognize and manage language delays. Specifically, they will: Define and understand language delay. Recognize the initial signs and symptoms of language delays. Identify and explain clinical pearls of potential etiologies of language delays. Recognize the developmental milestones for language based on age. Discuss the prevalence of language delays as well as identify the risk factors and patient demographics that have an increased susceptibility. Understand the initial diagnostic approach to the child with suspected language delay. Review the most common interventions when a child has language delay. Understand how to best discuss the prognosis for language delays and counsel the families and caregivers CME Credit (requires free sign up):   link coming soon! References: Karani NF, Sher J, Mophosho M. The influence of screen time on children's language development: A scoping review. S Afr J Commun Disord. 2022 Feb 9;69(1):e1-e7. doi: 10.4102/sajcd.v69i1.825. PMID: 35144436; PMCID: PMC8905397. Law, James et al. “Speech and language therapy interventions for children with primary speech and/or language disorders.” The Cochrane Database of Systematic Reviews 2017,1 CD012490. 9 Jan. 2017, doi:10.1002/14651858.CD012490 Sices, Laura, and Marilyn Augustyn. “Expressive Language Delay (‘Late Talking') in Young Children.” Edited by Robert G Voigt and Mary Torchia, UptoDate, Wolters Kluwer, UpToDate, Inc., 25 Jan. 2022, https://www.uptodate.com/contents/expressive-language-delay-late-talking-in-young-children. Spratt, Eve G et al. “The Effects of Early Neglect on Cognitive, Language, and Behavioral Functioning in Childhood.” Psychology (Irvine, Calif.) 3,2 (2012): 175-182. doi:10.4236/psych.2012.32026 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3652241/ Sunderajan, Trisha, and Sujata V Kanhere. “Speech and language delay in children: Prevalence and risk factors.” Journal of family medicine and primary care 8,5 (2019): 1642-1646. doi:10.4103/jfmpc.jfmpc_162_19 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6559061/ Takahashi I, Obara T, Ishikuro M, et al. Screen Time at Age 1 Year and Communication and Problem-Solving Developmental Delay at 2 and 4 Years. JAMA Pediatr.Published online August 21, 2023. doi:10.1001/jamapediatrics.2023.3057 Young, Allen. and Matthew Ng. “Genetic Hearing Loss.” StatPearls, StatPearls Publishing, 17 April 2023. https://www.ncbi.nlm.nih.gov/books/NBK580517/ Zuckerman B, Khandekar A. Reach Out and Read: evidence based approach to promoting early child development. Curr Opin Pediatr. 2010 Aug;22(4):539-44. doi: 10.1097/MOP.0b013e32833a4673. PMID: 20601887.

To Snip or Not to Snip - prepare for a “Cut” above the rest. On this episode of the MCG Pediatric Podcast, Dr. Bradley Morganstern, a Pediatric Urology physician, joins General Pediatrician Dr. Lauren Smith and Pediatric Resident Dr. My Duyen Vo to discuss the procedure of routine neonatal male circumcision, including benefits, potential complications, and contraindications. In this podcast, they will: Review the basic procedure for routine neonatal circumcision Discuss the benefits and risks associated with circumcision Depict the potential complications from circumcision that may require further intervention from urology Present the current guidelines on male circumcision from the American Academy of Pediatrics (AAP) Explore the history and cultural traditions surrounding circumcision Special thanks to Dr. Rebecca Yang and Dr. Alice Little Caldwell for peer reviewing this episode CME Credit (requires free sign up): Link coming soon! References: Aggleton, Peter (2007). “Just a Snip?”: A Social History of Male Circumcision, Reproductive Health Matters, 15:29, 15-21, DOI: 10.1016/S0968-8080(07)29303-6 Blank MD, S., Brady MD, M., Buerk MD, E., Carlo MD, W., Diekema MD, D., Freedman MD, A., Maxwell MD, L., Wegner MD, S. (2012). TASK FORCE ON CIRCUMCISION. Circumcision Policy Statement. Pediatrics, 130 (3): 585-586. https://doi.org/10.1542/peds.2012-1989 Blank MD, S., Brady MD, M., Buerk MD, E., Carlo MD, W., Diekema MD, D., Freedman MD, A., Maxwell MD, L., Wegner MD, S. (2012). TASK FORCE ON CIRCUMCISION. Male Circumcision Technical Report. Pediatrics, 130 (3): e756–e785. 10.1542/peds.2012-1990 Centers for Disease Control and Prevention (CDC). (2021). Protect Your Baby from Bleeds – Talk to Your Healthcare Provider about Vitamin K [Fact Sheet]. U.S. Department of Health & Human Services. https://www.cdc.gov/ncbddd/blooddisorders/documents/vitamin-k-p.pdf Kaweblum, Y. A., Press, S., Kogan, L., et al (1984). Circumcision using the Mogen clamp. Clin Pediatr (Phila.) 23:679-82. Morris, B. J., Bailis, S. A., Wiswell, T. E. (2014). Circumcision Rates in the United States: Rising or Falling? What Effect Might the New Affirmative Pediatric Policy Statement Have? Mayo Clinic Proceedings, 89 (5): 677-686. https://doi.org/10.1016/j.mayocp.2014.01.001 Owings M, Uddin S, Williams S. (2013). Trends in circumcision for male newborns in U.S. hospitals: 1979-2010. Atlanta, Georgia: Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/data/hestat/circumcision_2013/circumcision_2013.pdf Smith, L. The History of Male Infant Circumcision(Medical resident thesis).  WHO, UNAIDS (2010). Neonatal and child male circumcision: A global review. www.circlist.com/considering/neonatal_child_MC_UNAIDS.pdf

Did you know that approximately 1 in 5 children experience learning and attention issues, but only a fraction of them receives an official diagnosis? In this episode of the MCG Pediatric Podcast, hosts Rishab Chawla and Dr. Jennifer Poon delve into the topic of Specific Learning Disorders (SLDs). They discuss the prevalence, diagnostic criteria, assessment methods, and treatment interventions for SLDs. The conversation aims to provide a comprehensive understanding of SLDs and highlight the importance of early intervention and support. CME Credit (requires free sign up): Link coming soon! References: Barto, A. The State of Learning Disabilities: Understanding the 1 in 5. Available from: https://ldaamerica.org/lda_today/the-state-of-learning-disabilities-today/. Dominguez, O. and P. Carugno, Learning Disability, in StatPearls. 2024, StatPearls Publishing: Treasure Island (FL). About learning disorders and disabilities. Available from: https://www.childrenshospital.org/conditions/learning-disorders-and-disabilities. Learning Disabilities: Overview. Available from: https://www.nhs.uk/conditions/learning-disabilities/. Intellectual Developmental Disorder (Intellectual Disability). 2022, American Psychiatric Association. Developmental, A.S.o. and B. Pediatrics, AAP Developmental and Behavioral Pediatrics, ed. R.G. Voigt, et al.: American Academy of Pediatrics. Burns, M.K., et al., Toward a Unified Response-to-Intervention Model: Multi-Tiered Systems of Support, in Handbook of Response to Intervention: The Science and Practice of Multi-Tiered Systems of Support, S.R. Jimerson, M.K. Burns, and A.M. VanDerHeyden, Editors. 2016, Springer US: Boston, MA. p. 719-732. Health Issues & Treatments for Spina Bifida. 2023; Available from: https://www.cdc.gov/NCBDDD/spinabifida/treatment.html. Leonard, H., et al., A systematic review of the biological, social, and environmental determinants of intellectual disability in children and adolescents. Frontiers in Psychiatry, 2022. 13. Snowling, M.J., A. Gallagher, and U. Frith, Family risk of dyslexia is continuous: individual differences in the precursors of reading skill. Child Dev, 2003. 74(2): p. 358-73. Felitti, V.J., et al., Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 1998. 14(4): p. 245-258. Zarei, K., et al., Adverse Childhood Experiences Predict Common Neurodevelopmental and Behavioral Health Conditions among U.S. Children. Children (Basel), 2021. 8(9). CDC's Developmental Milestones. 2023; Available from: https://www.cdc.gov/ncbddd/actearly/milestones/index.html. Lipkin, P.H., et al., Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening. Pediatrics, 2020. 145(1). IEP and 504 plans. Available from: https://www.choa.org/-/media/Files/Childrens/patients/school-program/iep-504-resource-page.pdf?la=en&hash=BF719764C11B474F8659306C061E00FD938CE5D0. Individuals with Disabilities Education Act Sec. 300.8 Child with a disability. 2018. Affects focus, attention and behavior and can make learning challenging. Available from: https://ldaamerica.org/disabilities/adhd/. Sahoo, M.K., H. Biswas, and S.K. Padhy, Psychological Co-morbidity in Children with Specific Learning Disorders. Journal of Family Medicine and Primary Care, 2015. 4(1): p. 21-25. Ee, J., B. Stenfert Kroese, and J. Rose, A systematic review of the knowledge, attitudes and perceptions of health and social care professionals towards people with learning disabilities and mental health problems. British Journal of Learning Disabilities, 2022. 50(4): p. 467-483. From the Boston Globe: "How to Support your Dyslexic Child". 2021; Available from: https://dyslexia.yale.edu/boston-globe-support-dyslexic-child/. Resources https://ldaamerica.org/resources/ American Academy of Pediatrics. https://www.healthychildren.org/English/health-issues/conditions/learning-disabilities/Pages/default.aspx

Did you know that vision problems in children often go unnoticed until it's too late, potentially leading to irreversible vision loss? Dr. Steven Brooks, professor, and distinguished chair in ophthalmology at the Medical College of Georgia joins MCG students Emily Austin and Arjun Bhatt to uncover the hidden dangers of the 4 most common pediatric eye emergencies. Review four basic pediatric eye emergencies: amblyopia, strabismus, leukocoria, red eye emergencies Discuss causes, symptoms, treatment options, and the vital role pediatricians play in early detection and management. Review common case presentations of the emergent eye conditions in children Highlight the vital role pediatricians play in early detection and management. CME Credit (requires free sign up): Link Coming Soon! References: 1. Dr. Brook's Presentation on Common Pediatric Eye Emergencies Brook, D. (2023). Presentation on Common Pediatric Eye Emergencies [Google Slides presentation]. Retrieved from https://docs.google.com/presentation/d/1zpxZZnH5NTTpSq57HUegz_mC5zGkGrhK/edit?usp=share_link&ouid=107180084657435193874&rtpof=true&sd=true   2. AAO Pediatric Eye Evaluation Preferred Practice Patterns (2023) American Academy of Ophthalmology. (2023). Pediatric Eye Evaluation Preferred Practice Patterns [PDF]. Retrieved from https://nam02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.google.com%2Furl%3Fsa%3Dt%26source%3Dweb%26rct%3Dj%26opi%3D89978449%26url%3Dhttps%3A%2F%2Fwww.aao.org%2FAssets%2F0b507d20-f419-40ac-ac7c-99b11c95f58e%2F638070751054300000%2Fpediatric-eye-evaluations-ppp-pdf%26ved%3D2ahUKEwiv7P2E1NiFAxXZ4ckDHaPhBhsQFnoECBIQAQ%26usg%3DAOvVaw3ortok8vheUdG_OypWrm4N&data=05%7C02%7CARJBHATT%40augusta.edu%7C2d7137e07d264c7c962708dc6b0c56cb%7C8783ac6bd05b4292b483e65f1fdfee91%7C0%7C0%7C638502947937678385%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=IWSuIMyXuRbmeSh8riz7hbKZaSWRQLkcClHDexm7n58%3D&reserved=0   3. AAO Amblyopia Preferred Practice Pattern (2024) American Academy of Ophthalmology. (2024). Amblyopia Preferred Practice Pattern. Retrieved from https://www.aao.org/education/preferred-practice-pattern/amblyopia-ppp-2022   4. AAPOS Guidelines for Pediatric Eye Condition (2022) American Association for Pediatric Ophthalmology and Strabismus. (2022). Guidelines for Pediatric Eye Condition. Retrieved from https://www.jaapos.org/article/S1091-8531(22)00009-X/fulltext#:~:text=Astigmatism%2520%253E3.0%2520D%2520in%2520any,Δ%2520should%2520also%2520be%2520identified. 5. AAO Stepwise Approach to Leukocoria (2016) American Academy of Ophthalmology. (2016). Stepwise Approach to Leukocoria. Retrieved from https://www.aao.org/eyenet/article/stepwise-approach-to-leukocoria 6. First Aid (2023) Le, Tao; Bhushan, Vikas; Qiu, Connie; Chalise, Anup; and Kaparaliotis, Panagiotis. First Aid for the USMLE Step 1 2023. New York: McGraw Hill LLC, 2023.    

There has long since been a knowledge gap in medical education regarding care of LGBTQIA+ patients. This has manifested itself in health disparities that detrimentally affect the LGBTQIA+ population. This podcast serves as a way to start bridging the gap on order to mitigate the effects of bias, discrimination, and prejudice that queer patients often face in health care. Research has shown that consistent, early exposure in medical education to patients from the queer community has been beneficial in preparing future practitioners for gender inclusive care. We must also do our parts as pediatricians to make sure our queer youth grow into confident, thriving queer adults.  Join Dr. Farrah-Amoy Fullerton, a recent graduate of the pediatric residency program at MCG, and Professor of Pediatrics, Dr. Lisa Leggio, as they introduce LGBTQIA+ health care disparities and describe ways to bridge the gap for eager general practitioners who would like to know more. CME Credit (requires free sign up): Link Coming Soon! References: Bonvicini, K. A. (2017). LGBT healthcare disparities: What progress have we made? Patient Education and Counseling, 100(12), 2357–2361. https://doi.org/10.1016/j.pec.2017.06.003 Fish, J. N. (2020). Future directions in understanding and addressing mental health among LGBTQ youth. Journal of Clinical Child & Adolescent Psychology, 49(6), 943–956. https://doi.org/10.1080/15374416.2020.1815207 Nowaskie, D. Z., & Patel, A. U. (2020). How much is needed? patient exposure and curricular education on medical students' LGBT cultural competency. BMC Medical Education, 20(1). https://doi.org/10.1186/s12909-020-02381-1 Ormiston, C. K., & Williams, F. (2021). LGBTQ youth mental health during COVID-19: Unmet needs in public health and policy. The Lancet, 399(10324), 501–503. https://doi.org/10.1016/s0140-6736(21)02872-5 Reisman, T., & Goldstein, Z. (2018). Case report: Induced lactation in a transgender woman. Transgender Health, 3(1), 24–26. https://doi.org/10.1089/trgh.2017.0044 Reisner, S. L., Bradford, J., Hopwood, R., Gonzalez, A., Makadon, H., Todisco, D., Cavanaugh, T., VanDerwarker, R., Grasso, C., Zaslow, S., Boswell, S. L., & Mayer, K. (2015). Comprehensive Transgender Healthcare: The gender affirming clinical and public health model of Fenway Health. Journal of Urban Health, 92(3), 584–592. https://doi.org/10.1007/s11524-015-9947-2 Underman, K., Giffort, D., Hyderi, A., & Hirshfield, L. E. (2016). Transgender Health: A standardized patient case for advanced clerkship students. MedEdPORTAL. https://doi.org/10.15766/mep_2374-8265.10518 Wamboldt, R., Shuster, S., & Sidhu, B. S. (2021). Lactation induction in a transgender woman wanting to breastfeed: Case report. The Journal of Clinical Endocrinology & Metabolism, 106(5). https://doi.org/10.1210/clinem/dgaa976 Wylie, K., Knudson, G., Khan, S. I., Bonierbale, M., Watanyusakul, S., & Baral, S. (2016). Serving transgender people: Clinical Care Considerations and Service Delivery Models in transgender health. The Lancet, 388(10042), 401–411. https://doi.org/10.1016/s0140-6736(16)00682-6 The Williams Institute at UCLA School of Law. (2023, July 10). How many adults and youth identify as transgender in the United States? - Williams Institute. Williams Institute. https://williamsinstitute.law.ucla.edu/publications/trans-adults-united-states/ https://implicit.harvard.edu/implicit/takeatest.html Coleman E, Radix AE, Bouman WP, et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgend Health. 2022;23(Suppl 1):S1-S259. Published 2022 Sep 6. doi:10.1080/26895269.2022.2100644 https://pflag.org/ thetrevorproject.org

With the rise of social media, there has also been a rise in cyberbullying. Dr. Ruth Osondu, a child and adolescent psychiatry fellow joins Dr. Dale Peeples a child and adolescent psychiatrist and medical student Bailey Allen to discuss what pediatricians, parents, and teens should know about cyberbullying and suicide risks. Specifically, they will: Educate the listener and general community on signs a child/teenager at risk for suicide. Understand the effect of cyberbullying on the mental health of the child and adolescent population. Recognize signs that an adolescent is being cyberbullied. Understand potential preventative measures for cyberbullying. Recognize ways for a child or adolescent to get help if they are being bullied. Recognize the role of the parent of victims of cyberbullying CME Credit (requires free sign up): Link Coming Soon! References: Bauman S. Cyberbullying: What Does Research Tell Us? Theory Into Practice, Emerging Issues in School Bullying Research. 2013;52(4): 249-256. DOI: 10.1080/00405841.2013.829727 Chan T, Cheun C, Lee Z. Cyberbullying on Social Networking Sites: A Literature Review and and Future Research Directions. Information and Management. 2021;58(2):103411. https://doi.org/10.1016/j.im.202.103411. Earls M, Foy J, Green C.  “Mental Health Tools for Pediatrics”, Addressing Mental Health Concerns in Pediatrics: A Practical Resource Toolkit for Clinicians. American Academy of Pediatrics. February 2021. https://doi.org/10.1542/9781610024624-2e_s2_02_MH_tools_for_pediatrics Englander E, Donnerstein E, Kowalski R, Lin CA, Parti K. Defining Cyberbullying. Pediatrics. 2017 Nov;140(Suppl 2):S148-S151. doi: 10.1542/peds.2016-1758U. PMID: 29093051. Englander E. Back to the Drawing Board With Cyberbullying. JAMA Pediatr. 2019 Jun 1;173(6):513-514. doi: 10.1001/jamapediatrics.2019.0690. PMID: 31009032. Hamm MP, Newton AS, Chisholm A, Shulhan J, Milne A, Sundar P, Ennis H, Scott SD, Hartling L. Prevalence and Effect of Cyberbullying on Children and Young People: A Scoping Review of Social Media Studies. JAMA Pediatr. 2015 Aug;169(8):770-7. doi: 10.1001/jamapediatrics.2015.0944. PMID: 26098362. John A, Glendenning AC, Marchant A, Montgomery P, Stewart A, Wood S, Lloyd K, Hawton K. Self-Harm, Suicidal Behaviours, and Cyberbullying in Children and Young People: Systematic Review. J Med Internet Res. 2018 Apr 19;20(4):e129. doi: 10.2196/jmir.9044. PMID: 29674305; PMCID: PMC5934539. Timmons-Mitchell J, Flannery D; What Pediatricians Should Know and Do about Cyberbullying. Pediatr Rev. July 2020; 41 (7): 373–375. https://doi.org/10.1542/pir.2019-0165 Tozzo P, Cuman O, Moratto E, Caenazzo L. Family and Educational Strategies for Cyberbullying Prevention: A Systematic Review. Int J Environ Res Public Health. 2022 Aug 22;19(16):10452. doi: 10.3390/ijerph191610452. PMID: 36012084; PMCID: PMC9408628. John A, Glendenning AC, Marchant A, Montgomery P, Stewart A, Wood S, Lloyd K, Hawton K. Self-Harm, Suicidal Behaviours, and Cyberbullying in Children and Young People: Systematic Review. J Med Internet Res. 2018 Apr 19;20(4):e129. doi: 10.2196/jmir.9044. PMID: 29674305; PMCID: PMC5934539. Walrave, Michel, and Wannes Heirman. "Cyberbullying: Predicting victimisation and perpetration." Children & Society 25.1 (2011): 59-72.  

Did you know that the treatments used to cure pediatric cancers can potentially cause a life-threatening event known as tumor lysis syndrome (TLS)? Arfa Ul-Haque and Yazmin Reategui, two third-year medical students, are joined by Pediatric intensivist, Dr. Smitha Mathew, to discuss the evaluation and management for TLS so that it is promptly recognized and treated in the inpatient hospital setting.   Specifically, they will:  Review the basic assessment skills and evaluation for a child presenting with potential TLS   Discuss the influence of chemotherapy, initial presentation, diagnostic options, and management of electrolyte imbalances found in TLS  Medications reviewed: daunorubicin, cytarabine, calcium gluconate, Rasburicase, allopurinol  Anticipatory guidance to medical professionals for potential onset of TLS  Special thanks to Dr. Eric Ring and Dr. Rebecca Yang for peer reviewing this episode. References: Tumor lysis syndrome. (2022, October 4). Medscape.com. https://emedicine.medscape.com/article/282171-overview Adeyinka A, Bashir K. Tumor Lysis Syndrome. [Updated 2022 Oct 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518985/ Cheung WL, Hon KL, Fung CM, Leung AKC. Tumor lysis syndrome in childhood malignancies. Drugs in Context 2020; 9: 2019-8-2. DOI: 10.7573/dic.2019-8-2 Cheung, Ho Hung MBBSa; She, Wong Hoi MBBSa,∗; Yap, Desmond Y.H. MDb; Tsang, Simon H.Y. MBChBa; Cheung, Tan To MDc. A case report of tumor lysis syndrome after stage-one ALPPS. Medicine 101(10):p e29040, March 11, 2022. | DOI: 10.1097/MD.0000000000029040 Flood, K., Rozmus, J., Skippen, P., Matsell, D. G., & Mammen, C. (2021). Fluid overload and acute kidney injury in children with tumor lysis syndrome. Pediatric Blood & Cancer, 68(12), e29255. https://doi.org/10.1002/pbc.29255 Barbar T, Jaffer Sathick I. Tumor Lysis Syndrome. Adv Chronic Kidney Dis. 2021 Sep;28(5):438-446.e1. doi: 10.1053/j.ackd.2021.09.007. PMID: 35190110. Adeyinka A, Bashir K. Tumor Lysis Syndrome. [Updated 2022 Oct 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518985/ Shenoy MT, D'Souza B, Akshatha LN, D'Souza V, Rajan MG. Spontaneous Tumor Lysis Syndrome in an Infant: A Case Report. Indian J Clin Biochem. 2015 Jul;30(3):360-2. doi: 10.1007/s12291-014-0472-y. Epub 2015 Feb 14. PMID: 26089626; PMCID: PMC4469048. Alakel N, Middeke JM, Schetelig J, Bornhäuser M. Prevention and treatment of tumor lysis syndrome, and the efficacy and role of rasburicase. Onco Targets Ther. 2017 Feb 2;10:597-605. doi: 10.2147/OTT.S103864. PMID: 28203093; PMCID: PMC5295804. Kollathodi SB, Parameswaran KK, Madhavan L, Kuruvilla S. Hematological malignancies presenting as spontaneous tumor lysis syndrome: A case series. J Family Med Prim Care. 2018 Sep-Oct;7(5):1116-1119. doi: 10.4103/jfmpc.jfmpc_171_18. PMID: 30598972; PMCID: PMC6259502.    

Did you know that undiagnosed developmental dysplasia of the hip (DDH) is the most common cause of arthritis in women under 40? Dr. Melissa Allen, a Pediatric Orthopedic Surgeon, joins 3rd year Pediatric Resident Erica DeMaagd and 4th year medical student Jacob Weiser to discuss the evaluation and management for DDH.  Specifically, they will teach how to:  Recognize common history and physical exam findings associated with hip dysplasia. Be able to formulate a differential diagnosis for hip dysplasia. Understand the initial diagnostic approach to hip dysplasia. Select appropriate imaging to evaluate for hip dysplasia. Help parents understand initial treatment. Create an appropriate disposition for patients with abnormal hip exams. Recognize when to refer patients with hip dysplasia (condition) to orthopedic surgery (specialists). Special thanks to Dr. Lisa Leggio and Dr. Rebecca Yang for peer reviewing this episode. CME Credit (requires free sign up):  Link coming soon! References: Auriemma, J., & Potisek, N. M. (2018). Developmental dysplasia of the hip. Pediatrics In Review, 39(11), 570–572. https://doi.org/10.1542/pir.2017-0239 Barrera, C. A., Cohen, S. A., Sankar, W. N., Ho-Fung, V. M., Sze, R. W., & Nguyen, J. C. (2019). Imaging of Developmental Dysplasia of the hip: Ultrasound, Radiography and Magnetic Resonance Imaging. Pediatric Radiology, 49(12), 1652–1668. https://doi.org/10.1007/s00247-019-04504-3 Centers for Disease Control and Prevention. (2022, December 8). Important Milestones: Your Baby by One Year. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/actearly/milestones/milestones-1yr.html Imrie, M., Scott, V., Stearns, P., Bastrom, T., & Mubarak, S. J. (2010). Is Ultrasound Screening for DDH in Babies Born Breech Sufficient? Journal of Children's Orthopaedics, 4(1), 3–8. Larson, J. E., Patel, A. R., Weatherford, B., & Janicki, J. A. (2019). Timing of Pavlik Harness Initiation: Can We wait? Journal of Pediatric Orthopaedics, 39(7), 335–338. https://doi.org/10.1097/bpo.0000000000000930 Mahan, S. T., Katz, J. N., & Kim, Y.-J. (2009). To Screen or Not to Screen? A Decision Analysis of the Utility of Screening for Developmental Dysplasia of the Hip. The Journal of Bone and Joint Surgery-American Volume, 91(7), 1705–1719. https://doi.org/10.2106/jbjs.h.00122 Nemeth, B. A., & Narotam, V. (2012). Developmental Dysplasia of the Hip. Pediatrics in Review, 33(12), 553–561. https://doi.org/10.1542/pir.33-12-553 Novais, E. (2018). Pavlik Harness. Boston, MA; Boston Children's Hospital Child and Young Adult Hip Preservation Program. Shaw BA, Segal LS, AAP SECTION ON ORTHOPAEDICS. Evaluation and Referral for                                    Developmental Dysplasia of the Hip in Infants. Pediatrics. 2016;138(6):e20163107 Scott Yang, Natalie Zusman, Elizabeth Lieberman, Rachel Y. Goldstein; Developmental Dysplasia of the Hip. Pediatrics January 2019; 143 (1): e20181147. 10.1542/peds.2018-1147  

Community acquired pneumonia is unfortunately a common condition seen in children of all ages. Dr. Jacob Eichenberger, an associate professor of pediatrics at MCG and a pediatric hospitalist at the Children's Hospital of Georgia, joins recently graduated pediatric resident, Dr. Fahim Thawer, and medical student Sara Attari to discuss the evaluation and management of community acquired pneumonia. Specifically, they will: • Discuss common history and physical exam findings associated with community acquired pneumonia • Formulate a differential diagnoses • Work through the initial diagnostic approach and treatment  • Discuss prognosis and prevention

Coughs are one of the most common symptoms of childhood illness. But when should we start to get worried? What is a child's cough trying to tell you? Dr. Sunil Kapoor, a Pediatric Pulmonology Physician, joins Dr. Rebecca Yang and medical student Aparna Prasad to discuss the evaluation and management of chronic cough in children.  Specifically, they will:  Review the history and physical examination for a child presenting with a chronic cough Discuss the treatment for the most common causes of cough in children Evaluate the symptoms that suggest an underlying immunodeficiency Review the criteria for a referral to pulmonology Special thanks to Dr. Dionne Adair, Dr.Sunil Kapoor, and Dr. Rebecca Yang for peer reviewing this episode. CME Credit (requires free sign up): Link Coming Soon! References: Marchant, J. (2021, September 30). Causes of chronic cough in children. UpToDate. Retrieved June 2, 2022, from https://www.uptodate.com/contents/causes-of-chronic-cough-in-children?search=common+causes+of+chronic+cough+in+young+kids&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1    Chang, A. (2020, November 18). Approach to chronic cough in children. UpToDate. Retrieved June 2, 2022, from https://www.uptodate.com/contents/approach-to-chronic-cough-in-children?search=common+causes+of+chronic+cough+in+young+kids&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2    Gregory, S. (2021, May 4). Asthma in children younger than 12 years: Overview of initiating therapy and monitoring control. UpToDate. Retrieved June 2, 2022, from https://www.uptodate.com/contents/asthma-in-children-younger-than-12-years-overview-of-initiating-therapy-and-monitoring-control?search=chronic+cough+in+children&topicRef=91328&source=related_link    Pratter M. Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 suppl):63S-71S.

Did you know around 15 to 25% of children will have at least one syncopal episode before adulthood? Join medical students Sanya Dudani and Caleb Robertson, along with Pediatric Cardiologist Dr. John Plowden, as they discuss the evaluation and management of syncope in the pediatric patient.  Specifically, they will: Discuss the definition of syncope and its underlying pathophysiology Recall the incidence and risk factors of syncope in the pediatric population Describe the various etiologies and their distinguishing factors Understand the proper approach to taking a history for a pediatric patient with a chief complaint of syncope Recognize findings on the physical exam that help narrow the differential diagnosis Understand the appropriate lab tests and imaging needed Discuss when it's appropriate to refer patients to specialists Special thanks to Dr. Rebecca Yang and Dr. Melissa Lefebvre for peer reviewing this episode! CME Credit (requires free sign up): Link Coming Soon! References: Arthur W, Kaye GC  The pathophysiology of common causes of syncope  Postgraduate Medical Journal 2000;76:750-753. Cipolla MJ. The Cerebral Circulation. San Rafael (CA): Morgan & Claypool Life Sciences; 2009. Chapter 5, Control of Cerebral Blood Flow. Available from: https://www.ncbi.nlm.nih.gov/books/NBK53082/ Clark, BC, Hayman, JM, Berul, CI, Burns, KM, and Kaltman, JR. Selective use of the electrocardiogram in pediatric preparticipation athletic examinations among pediatric primary care providers. Ann Noninvasive Electrocardiol. 2017; 22:e12446. https://doi.org/10.1111/anec.12446] De, A. and Davidson Ward, S.L. (2014), Syncope at altitude: An enigmatic case. Pediatr Pulmonol., 49: E144-E146. https://doi.org/10.1002/ppul.23062 Gupta A, Menoch M, Levasseur K, Gonzalez IE. Screening Pediatric Patients in New-Onset Syncope (SPINS) Study. Clinical Pediatrics. 2020;59(2):127-133. doi:10.1177/0009922819885660 Hainsworth, R. Pathophysiology of syncope. Clin Auton Res 14 (Suppl 1), i18–i24 (2004). https://doi.org/10.1007/s10286-004-1004-2 Phillip A. Low, Paola Sandroni, Chapter 106 - Postural Tachycardia Syndrome (POTS), Editor(s): David Robertson, Italo Biaggioni, Geoffrey Burnstock, Phillip A. Low, Julian F.R. Paton, Primer on the Autonomic Nervous System (Third Edition), Academic Press, 2012, Pages 517-519, ISBN 9780123865250, https://doi.org/10.1016/B978-0-12-386525-0.00106-2 Zavala, Rennette MD∗; Metais, Benjamin MD†; Tuckfield, Lynnia BS‡; DelVecchio, Michael MD‡; Aronoff, Stephen MD, MBA‡. Pediatric Syncope: A Systematic Review. Pediatric Emergency Care: September 2020 - Volume 36 - Issue 9 - p 442-445 doi: 10.1097/PEC.0000000000002149 

Did you know that 80% of children with biliary atresia who undergo a Kasai procedure will still require liver transplant at some point in their life? Dr. Bade, a pediatric gastroenterologist, joins medical students Tucker Oliver and Sarah Chappell to discuss evaluation and management of infants with biliary atresia. Specifically, they will: Discuss the presentation and diagnosis of biliary atresia Explain pathophysiology behind jaundice Discuss preoperative and postoperative recommendations for the Kasai procedure Review complications and outcomes of the Kasai procedure Share advice for navigating the diagnosis of biliary atresia with families Special thanks to Dr. Rebecca Yang and Dr. Jennifer Tucker for peer reviewing this episode. FREE CME Credit (requires free sign-up): Link Coming Soon! References:  1]          P. J. Lupo et al., “Population-based birth defects data in the United States, 2010-2014: A focus on gastrointestinal defects.,” Birth Defects Res, vol. 109, no. 18, pp. 1504–1514, Nov. 2017, doi: 10.1002/bdr2.1145. [2]         J. L. Hartley, M. Davenport, and D. A. Kelly, “Biliary atresia,” The Lancet, vol. 374, no. 9702, pp. 1704–1713, Nov. 2009, doi: 10.1016/S0140-6736(09)60946-6. [3]         S. S. Sundaram, C. L. Mack, A. G. Feldman, and R. J. Sokol, “Biliary atresia: Indications and timing of liver transplantation and optimization of pretransplant care.,” Liver Transpl, vol. 23, no. 1, pp. 96–109, Jan. 2017, doi: 10.1002/lt.24640. [4]         D. Volpert, F. White, M. J. Finegold, J. Molleston, M. DeBaun, and D. H. Perlmutter, “Outcome of Early Hepatic Portoenterostomy for Biliary Atresia,” J Pediatr Gastroenterol Nutr, vol. 32, no. 3, pp. 265–269, Mar. 2001, doi: 10.1097/00005176-200103000-00006. [5]         R. Fawaz et al., “Guideline for the Evaluation of Cholestatic Jaundice in Infants: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition.,” J Pediatr Gastroenterol Nutr, vol. 64, no. 1, pp. 154–168, Jan. 2017, doi: 10.1097/MPG.0000000000001334. [6]         P. H. Y. Chung et al., “Life long follow up and management strategies of patients living with native livers after Kasai portoenterostomy.,” Sci Rep, vol. 11, no. 1, p. 11207, May 2021, doi: 10.1038/s41598-021-90860-w. [7]         E. H. Gad, Y. Kamel, T. A.-H. Salem, M. A.-H. Ali, and A. N. Sallam, “Short- and long-term outcomes after Kasai operation for type III biliary atresia: Twenty years of experience in a single tertiary Egyptian center-A retrospective cohort study.,” Ann Med Surg (Lond), vol. 62, pp. 302–314, Feb. 2021, doi: 10.1016/j.amsu.2021.01.052. [8]         A. M. Calinescu et al., “Cholangitis Definition and Treatment after Kasai Hepatoportoenterostomy for Biliary Atresia: A Delphi Process and International Expert Panel.,” J Clin Med, vol. 11, no. 3, Jan. 2022, doi: 10.3390/jcm11030494. [9]         S. Kiriyama et al., “Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos),” J Hepatobiliary Pancreat Sci, vol. 25, no. 1, pp. 17–30, Jan. 2018, doi: 10.1002/jhbp.512. [10]      K. Decharun, C. M. Leys, K. W. West, and S. M. E. Finnell, “Prophylactic Antibiotics for Prevention of Cholangitis in Patients With Biliary Atresia Status Post-Kasai Portoenterostomy,” Clin Pediatr (Phila), vol. 55, no. 1, pp. 66–72, Jan. 2016, doi: 10.1177/0009922815594760. [11]      E. Jung, W.-H. Park, and S.-O. Choi, “Late complications and current status of long-term survivals over 10 years after Kasai portoenterostomy.,” J Korean Surg Soc, vol. 81, no. 4, pp. 271–5, Oct. 2011, doi: 10.4174/jkss.2011.81.4.271. [12]      S. S. Sundaram et al., “Health related quality of life in patients with biliary atresia surviving with their native liver.,” J Pediatr, vol. 163, no. 4, pp. 1052–7.e2, Oct. 2013, doi: 10.1016/j.jpeds.2013.04.037. [13]      B. L. Shneider et al., “Efficacy of fat-soluble vitamin supplementation in infants with biliary atresia.,” Pediatrics, vol. 130, no. 3, pp. e607-14, Sep. 2012, doi: 10.1542/peds.2011-1423. [14]      J. P. Molleston and B. L. Shneider, “Preventing variceal bleeding in infants and children: is less more?,” Gastroenterology, vol. 145, no. 4, pp. 719–22, Oct. 2013, doi: 10.1053/j.gastro.2013.08.026. [15]      G. Grisotti and R. A. Cowles, “Complications in pediatric hepatobiliary surgery,” Semin Pediatr Surg, vol. 25, no. 6, pp. 388–394, Dec. 2016, doi: 10.1053/j.sempedsurg.2016.10.004. [16]      F. R. Sinatra, “Consultation with the Specialist: Liver Transplantation for Biliary Atresia,” Pediatr Rev, vol. 22, no. 5, pp. 166–168, May 2001, doi: 10.1542/pir.22-5-166. [17]      I. Sriram and D. Nicklas, “Biliary Atresia,” Pediatr Rev, vol. 43, no. 11, pp. 659–661, Nov. 2022, doi: 10.1542/pir.2021-005287. [18]      L. H. Rodijk et al., “Parental wellbeing after diagnosing a child with biliary atresia: A prospective cohort study.,” J Pediatr Surg, vol. 57, no. 4, pp. 649–654, Apr. 2022, doi: 10.1016/j.jpedsurg.2021.05.026. [19]      A. Sanchez-Valle, N. Kassira, V. C. Varela, S. C. Radu, C. Paidas, and R. S. Kirby, “Biliary Atresia: Epidemiology, Genetics, Clinical Update, and Public Health Perspective.,” Adv Pediatr, vol. 64, no. 1, pp. 285–305, Aug. 2017, doi: 10.1016/j.yapd.2017.03.012.

Did you know that salicylate containing substances alone were responsible for over 6,000 cases of pediatric poison exposures in 2020? Dr. Arden Conway, a Pediatric Critical Care Physician, joins Medical Students Morgan Franklin and Ifrah Waris to discuss the evaluation and management for salicylate overdose in a pediatric patient. Specifically, they will:  • Review the pathophysiology of salicylate toxicity • Review the basic assessment skills for acutely ill pediatric patients • Discuss the diagnostic options and evaluation for a child presenting with a potential salicylate overdose • Discuss the management and monitoring of salicylate overdose • Medications and treatments reviewed: activated charcoal, elimination enhancement, hemodialysis  • Discuss the potential complications of salicylate overdose Special thanks to Dr. Rebecca Yang and Dr. Jennifer Tucker for peer reviewing this episode. FREE CME Credit (requires free sign-up): Link Coming Soon! References:  Anderson, M. (2021). Initial management of suspected poisoning in children and young people. Paediatrics and Child Health, 31(10), 382-387. Chyka PA, Erdman AR, Christianson G, Wax PM, Booze LL, Manoguerra AS, Caravati EM, Nelson LS, Olson KR, Cobaugh DJ, Scharman EJ, Woolf AD, Troutman WG; Americal Association of Poison Control Centers; Healthcare Systems Bureau, Health Resources and Sevices Administration, Department of Health and Human Services. Salicylate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(2):95-131. doi: 10.1080/15563650600907140. Darracq, M. A., & Cantrell, F. L. (20136). Hemodialysis and extracorporeal removal after pediatric and adolescent poisoning reported to a state poison center. The Journal of Emergency Medicine., 44(6), 1101–1107. https://doi.org/10.1016/j.jemermed.2012.12.018 Espírito Santo, R., Vaz, S., Jalles, F., Boto, L., & Abecasis, F. (2017). Salicylate Intoxication in an Infant: A Case Report. Drug safety - case reports, 4(1), 23. https://doi.org/10.1007/s40800-017-0065-9 Gummin DD, Mowry JB, Beuhler MC, Spyker DA, Bronstein AC, Rivers LJ, Pham NPT, Weber J. 2020 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 38th Annual Report. Clin Toxicol (Phila). 2021 Dec;59(12):1282-1501. doi: 10.1080/15563650.2021.1989785. Mukerji V, Alpert MA, Flaker GC, Beach CL, Weber RD. Cardiac conduction abnormalities and atrial arrhythmias associated with salicylate toxicity. Pharmacotherapy. 1986 Jan-Feb;6(1):41-3. doi: 10.1002/j.1875-9114.1986.tb03449.x. Palmer, B. F., & Clegg, D. J. (2020). Salicylate toxicity. New England Journal of Medicine, 382(26), 2544-2555. Runde TJ, Nappe TM. Salicylates Toxicity. [Updated 2021 Jul 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499879/

Immunizations are a critical component of the well child management in pediatric patients, as they are responsible for the prevention of numerous serious diseases with devastating consequences even if adequately treated. While many providers are well versed in the standard immunization schedule for children, the care and management of under-immunized children may present itself a challenge. Join Dr. Shreeti Kapoor, a general pediatrician for over 25 years, and recent Pediatric Resident graduate, Dr. Monique Bailey as they discuss caring for under-immunized children. Specifically, they will: Review the recommended vaccination schedule for all children, with a focus on those aged 0-4 years. Discuss the CDC catch-up immunization schedule with examples from three different age groups. Consider the special case of catch-up vaccination for international adoptees as well as interpreting records containing other immunizations (e.g. BCG vaccine) from a few examples of international endemic areas. Review common causes of febrile illnesses in young, vaccinated and under-immunized children. Examine the treatment algorithm and recommended prophylactic antibiotic options for unvaccinated or under-immunized children. Special thanks to Dr. Leila Stallworth, Dr. Erica Sapp and Dr. Rebecca Yang for peer reviewing this episode. FREE CME Credit (requires free sign-up): Link Coming Soon! References:   Centers for Disease Control and Prevention. (2022, February 17). Birth-18 years immunization schedule. Centers for Disease Control and Prevention. Retrieved April 5, 2022, from https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html Centers for Disease Control and Prevention. (2022, February 17). Catch-up immunization schedule. Centers for Disease Control and Prevention. Retrieved April 5, 2022, from https://www.cdc.gov/vaccines/schedules/hcp/imz/catchup.html Finkel, L. , Ospina-Jimenez, C. , Byers, M. & Eilbert, W. (2021). Fever Without Source in Unvaccinated Children Aged 3 to 24 Months. Pediatric Emergency Care, 37 (12), e882-e885. doi: 10.1097/PEC.0000000000002249. Starr M. (2013). Paediatric travel medicine: vaccines and medications. British journal of clinical pharmacology, 75(6), 1422–1432. https://doi.org/10.1111/bcp.12035 NHS. (2019, April 26). BCG vaccine for tuberculosis (TB) overview. NHS choices. Retrieved April 6, 2022, from https://www.nhs.uk/conditions/vaccinations/bcg-tuberculosis-tb-vaccine/ Centers for Disease Control and Prevention. (2019, October 30). Typhoid vaccine information statement. Centers for Disease Control and Prevention. Retrieved April 6, 2022, from https://www.cdc.gov/vaccines/hcp/vis/vis-statements/typhoid.html#:~:text=There%20are%20two%20vaccines%20to,as%20an%20injection%20(shot) Lopez, A. L., Gonzales, M. L., Aldaba, J. G., & Nair, G. B. (2014). Killed oral cholera vaccines: history, development and implementation challenges. Therapeutic advances in vaccines, 2(5), 123–136. https://doi.org/10.1177/2051013614537819 Lee DID, Vanderhout S, Aglipay M, Birken CS, Morris SK, Piché-Renaud PP, Keown-Stoneman CDG, Maguire JL. Delay in childhood vaccinations during the COVID-19 pandemic. Can J Public Health. 2022 Feb;113(1):126-134. doi: 10.17269/s41997-021-00601-9 Kroger A, Bahta L, Hunter P. General best practice guidelines for immunization. Best practices guidance of the Advisory Committee on Immunization Practices (ACIP). Special situations. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/special-situations.html

Have you ever eaten something and began feeling itchiness and tingling of your lips or throat? This could be due to PFAS, which stands for Pollen-Food Allergy Syndrome. PFAS is a hypersensitivity reaction that can occur in individuals who have seasonal allergic rhinitis. The symptoms are caused by a cross-reactivity between plant pollens and food proteins following the ingestion of certain fresh fruits, vegetables, and nuts. Join medical student Ryan Boykin and Pediatric Allergist Dr. Sarah Spriet as they discuss the evaluation, diagnosis, and management of PFAS.   After listening to this episode, leaners should be able to: Describe the pathophysiology of PFAS Understand the differences between PFAS and an IgE-mediated food allergy and identify the diagnostic studies that may aid in distinguishing between the two Recall common foods associated with PFAS and identify their cross-reactivity patterns Identify which patients are at greater risk of systemic reactions and when to prescribe an epinephrine auto-injector Identify when to refer patients to an Allergy & Immunology subspecialist  Special thanks to Dr. Richard Bickel and Dr. Rebecca Yang for peer review of content of this episode. FREE CME Credit (requires free sign-up): https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=19510 References: Bolhaar ST, et. al. Efficacy of birch-pollen immunotherapy on cross-reactive food allergy confirmed by skin tests and double-blind food challenges. Clin Exp Allergy. 2004 May;34(5):761-9. doi: 10.1111/j.1365-2222.2004.1939.x. PMID: 15144469. Carlson, G., & Coop, C. (2019). Pollen food allergy syndrome (PFAS): a review of current available literature. Annals of Allergy, Asthma & Immunology, 123(4), 359-365. Osterballe M, Hansen TK, Mortz CG, Bindslev-Jensen C. The clinical relevance of sensitization to pollen-related fruits and vegetables in unselected pollen-sensitized adults. Allergy. 2005 Feb;60(2):218-25. doi: 10.1111/j.1398-9995.2005.00674.x. PMID: 15647044. Poncet, P., Sénéchal, H., & Charpin, D. (2020). Update on pollen-food allergy syndrome. Expert Review of Clinical Immunology, 16(6), 561-578. Priyamvada Tatachar, Smita Kumar; Food-induced Anaphylaxis and Oral Allergy Syndrome. Pediatr RevApril 2008; 29 (4): e23–e27. https://doi.org/10.1542/pir.29-4-e23 Sicherer SH. Clinical implications of cross-reactive food allergens. J Allergy Clin Immunol. 2001 Dec;108(6):881-90. doi: 10.1067/mai.2001.118515. PMID: 11742262. Sicherer, S. H., Warren, C. M., Dant, C., Gupta, R. S., & Nadeau, K. C. (2020). Food allergy from infancy through adulthood. The Journal of Allergy and Clinical Immunology: In Practice, 8(6), 1854-1864.

Nocturnal enuresis is a common problem for pediatric patients that can be quite distressing for children as well as their parents. In this episode join Madeline Snipes, a medical student at the Medical College of Georgia as she discusses nocturnal enuresis with Chief of Pediatric Urology at the Children's Hospital of Georgia, Dr. Bradley Morganstern, and Associate Professor of Pediatrics, Dr. Susan Goldberg, on an overview of nocturnal enuresis. Specifically, they will review:  • The definition of nocturnal enuresis and its basic epidemiology.   • The potential causes of nocturnal enuresis.   • The appropriate workup for a pediatric patient with nocturnal enuresis.   • When referral to a pediatric urologist is indicated.   • The various treatment options for a pediatric patient with nocturnal enuresis.   • And finally the potential sequelae that may result from untreated nocturnal enuresis.  Special thanks to Dr. Jordan Gitlin, pediatric urologist at NYU's Winthrop Hospital, and Dr. Shreeti Kapoor, general pediatrician and associate professor of pediatric medicine at the Medical College of Georgia at Augusta University.  FREE CME Credit (requires free sign-up):  Link coming soon! References: 1. Nevéus T, Fonseca E, Franco I, et al. Management and treatment of nocturnal enuresis—an updated standardization document from the International Children's Continence Society. Journal of Pediatric Urology. 2020;16(1):10-19. doi:10.1016/j.jpurol.2019.12.020  2. Järvelin MR, Vikeväinen-Tervonen L, Moilanen I, Huttunen NP. Enuresis in seven-year-old children. Acta paediatrica Scandinavica. 1988;77(1):148-153. doi:10.1111/j.1651-2227.1988.tb10614.  3. de Sena Oliveira AC, Athanasio B da S, Mrad FC de C, et al. Attention deficit and hyperactivity disorder and nocturnal enuresis co-occurrence in the pediatric population: a systematic review and meta-analysis. Pediatric Nephrology. 2021;36(11):3547-3559. doi:10.1007/s00467-021-05083-y  4. Forsythe WI, Redmond A. Enuresis and spontaneous cure rate. Study of 1129 enuretis. Arch Dis Child. 1974;49(4):259-263. doi:10.1136/adc.49.4.259  5. von Gontard A, Mauer-Mucke K, Plück J, Berner W, Lehmkuhl G. Clinical behavioral problems in day- and night-wetting children. Pediatr Nephrol. 1999;13(8):662-667. doi:10.1007/s004670050677  6. Robson WL. Clinical practice. Evaluation and management of enuresis. N Engl J Med. 2009;360(14):1429-1436. doi:10.1056/NEJMcp0808009  7. Yeung CK, Sreedhar B, Sihoe JD, Sit FK, Lau J. Differences in characteristics of nocturnal enuresis between children and adolescents: a critical appraisal from a large epidemiological study. BJU Int. 2006;97(5):1069-1073. doi:10.1111/j.1464-410X.2006.06074.x  8. Sá CA, Martins de Souza SA, Villela MCBVA, et al. Psychological Intervention with Parents Improves Treatment Results and Reduces Punishment in Children with Enuresis: A Randomized Clinical Trial. J Urol. 2021;205(2):570-576. doi:10.1097/JU.0000000000001351  9. Jackson EC. Nocturnal enuresis: giving the child a "lift". J Pediatr. 2009;154(5):636-637. doi:10.1016/j.jpeds.2009.01.041  10. Plaire JC, Pope JC 4th, Kropp BP, et al. Management of ectopic ureters: experience with the upper tract approach. J Urol. 1997;158(3 Pt 2):1245-1247.  11. Alnatour IM, Alnashrati T. Nocturnal Enuresis. Middle East Journal of Family Medicine. 2022;20(7):127-131. doi:10.5742/MEWFM.2022.9525106  12. van Summeren JJGT, Holtman GA, van Ommeren SC, Kollen BJ, Dekker JH, Berger MY. Bladder Symptoms in Children With Functional Constipation: A Systematic Review. J Pediatr Gastroenterol Nutr. 2018;67(5):552-560. doi:10.1097/MPG.0000000000002138  13. Brownrigg N, Braga LH, Rickard M, et al. The impact of a bladder training video versus standard urotherapy on quality of life of children with bladder and bowel dysfunction: A randomized controlled trial. J Pediatr Urol. 2017;13(4):374.e1-374.e8. doi:10.1016/j.jpurol.2017.06.005 

Bringing home and caring for a newborn can be overwhelming for a new caregiver, but proper guidance and education in the newborn nursery can alleviate many worries… and be lifesaving! Dr. Nirupma Sharma, a Pediatric Hospitalist, is joined by fourth year medical student, and future pediatrician, Grace Porter to discuss key educational areas of newborn care essential for pediatricians and caregivers to know upon discharge from the hospital. Specifically, they will: Review key environmental safety factors for the newborn including safe sleep practices, smoke avoidance, caregiver awareness, infectious exposures, and car safety. Discuss normal feeding, voiding, stooling, and spitting up patterns for newborns with anticipatory guidelines for caregivers if infants deviate from those patterns. Special thanks to Dr. Alice Little Caldwell and Dr. Rebecca Yang for peer reviewing this episode. FREE CME Credit (requires free sign-up): https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=19508 References:  Rachel Y. Moon, Rebecca F. Carlin, Ivan Hand, THE TASK FORCE ON SUDDEN INFANT DEATH SYNDROME AND THE COMMITTEE ON FETUS AND NEWBORN; Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. Pediatrics July 2022; 150 (1): e2022057990. 10.1542/peds.2022-057990 Johanna B. Warren, Carrie A. Phillipi; Care of the Well Newborn. Pediatr Rev January 2012; 33 (1): 4–18. https://doi.org/10.1542/pir.33-1-4 American Academy of Pediatrics. (2022, March 16). Shaken baby syndrome: Protect your infant from abusive head trauma. HealthyChildren.org. Retrieved March 7, 2023, from https://www.healthychildren.org/English/safety-prevention/at-home/Pages/Abusive-Head-Trauma-Shaken-Baby-Syndrome.aspx Centers for Disease Control and Prevention. (2022, June 21). Data and statistics for SIDS and SUID. Centers for Disease Control and Prevention. Retrieved March 7, 2023, from https://www.cdc.gov/sids/data.htm Dangers of Secondhand Smoke . Pediatric Patient Education 2021; 10.1542/peo_document025 American Academy of Pediatrics. (2021, August 5). Baby's first days: Bowel movements & urination. HealthyChildren.org. Retrieved March 7, 2023, from https://www.healthychildren.org/English/ages-stages/baby/Pages/Babys-First-Days-Bowel-Movements-and-Urination.aspx Jennifer, K. (2022, May 9). How often, how much, what color: Your newborn poop and pee questions answered. Lurie Children's. Retrieved March 7, 2023, from https://www.luriechildrens.org/en/blog/what-to-know-about-newborn-poop-and-pee/ Pediatric Care Advice; Spitting Up (Normal Reflux). Pediatric Patient Education 2022; 10.1542/ppe_schmitt_225 Robert H. Pantell, Kenneth B. Roberts, William G. Adams, Benard P. Dreyer, Nathan Kuppermann, Sean T. O'Leary, Kymika Okechukwu, Charles R. Woods, SUBCOMMITTEE ON FEBRILE INFANTS; Clinical Practice Guideline: Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. Pediatrics August 2021; 148 (2): e2021052228. 10.1542/peds.2021-052228 Natasha, S. K. (2022, June 30). Depression during & after pregnancy: You are not alone. HealthyChildren.org. Retrieved March 7, 2023, from https://healthychildren.org/English/ages-stages/prenatal/delivery-beyond/Pages/understanding-motherhood-and-mood-baby-blues-and-beyond.aspx Dennis R. Durbin, Benjamin D. Hoffman, COUNCIL ON INJURY, VIOLENCE, AND POISON PREVENTION, Phyllis F. Agran, Sarah A. Denny, Michael Hirsh, Brian Johnston, Lois K. Lee, Kathy Monroe, Judy Schaechter, Milton Tenenbein, Mark R. Zonfrillo, Kyran Quinlan; Child Passenger Safety. Pediatrics November 2018; 142 (5): e20182460. 10.1542/peds.2018-2460

Noninvasive respiratory support is an important modality utilized in the pediatric critical care setting to treat respiratory failure without the use of an artificial airway. On today's discussion, pediatric critical care fellow, Dr. John-David Bruce joins pediatric hospitalist, Dr. Brynn Ehlers and Dr. Gene Fisher who is a pediatric intensivist that serves as the division chief of Pediatric Critical Care unit at the Children's Hospital of Georgia. After listening to this podcast, learners should be able to:  1. Recognize different types of noninvasive respiratory support 2. Have an understanding of basic settings involved in the different modes of noninvasive respiratory support 3. Discuss conditions that are most ideal for noninvasive respiratory support  4. Recognize when it is necessary to escalate to a higher mode of respiratory support 5. Common complications of noninvasive respiratory support and how do you treat them. FREE CME Credit (requires free sign-up):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=19507  References: Amin, R, & Arca, MJ. Feasibility of non-invasive neurally adjusted ventilator assist after congenital diaphragmatic hernia repair. Journal of Pediatric Surgery, 2019;54(3):434-438. Coletti, KD, Bagdure, DN, Walker, LK, Remy, KE, & Custer, JW. High-flow nasal cannula utilization in pediatric critical care. Respiratory Care, 2017;62(8):1023-1029. Desai, JP, & Moustarah, F. Pulmonary Compliance. StatPearls Publishing. 2021.  https://www.ncbi.nlm.nih.gov/books/NBK538324/ Fedor, KL. Noninvasive respiratory support in infants and children. Respiratory Care, 2017;62(6):699-717. Franklin, D, Babl, FE, & Schlapbach, LJ, et al. A randomized trial of high-flow oxygen therapy in infants with bronchiolitis. The New England Journal of Medicine, 2018;378:1121-1131. Intagliata, S, Rizzo, A, & Gossman, WG. Physiology, Lung Dead Space. StatPearls Publishing. 2020. https://www.ncbi.nlm.nih.gov/books/NBK482501/ Morrison, WE, Nelson McMillan, KL, & Shaffner, DH. (Eds.). Roger's Handbook of Pediatric Intensive Care (5th ed.). 2017. Wolters Kluwer. Najaf-Zadeh A, & Leclerc F. Noninvasive positive pressure ventilation for acute respiratory failure in children: a concise review. Ann Intensive Care. 2011;1(1):15. doi:10.1186/2110-5820-1-15 Oymar, K, & Bardsen, K. Continuous positive airway pressure for bronchiolitis in a general paediatric ward; a feasibility study. BMC Pediatrics. 2014;14:122. Pope, JF, & Birnkrant, DJ. Noninvasive ventilation to facilitate extubation in a pediatric intensive care unit. Journal of Intensive Care Medicine. 2000;15(2):99-103.  Storre, JH, Bohm, P, Dreher, M, & Windisch, W. Clinical impact of leak compensation during non-invasive ventilation. Respiratory Medicine. 2009;103(10):1477-1483.  Silver AH, Nazif JM. Bronchiolitis. Pediatr Rev. 2019;40(11):568-576. doi:10.1542/pir.2018-0260

Did you know that household Tylenol is one of the most common causes of both intentional and unintentional toxicity in the pediatric population? Dr. George Hsu, a Pediatric Emergency Physician, joins Dr. Rebecca Yang and Medical Students Morgan Franklin and Ifrah Waris to discuss the evaluation and management for acetaminophen overdose in a pediatric patient.  Specifically, they will:  Review the basic assessment skills and evaluation for a child presenting with a potential acetaminophen overdose Discuss the diagnostic options and monitoring of acetaminophen overdose Discuss how to use the Rumack-Matthew nomogram in the treatment of acetaminophen overdose Medications and treatments reviewed: N-acetylcysteine, activated charcoal, and gastric lavage Discuss the potential complications of acetaminophen overdose Special thanks to Dr. Rebecca Yang and Dr. Arden Conway for peer reviewing this episode. Special thanks to Dr. Rebecca Yang and Dr. Arden Conway for peer reviewing the discussion today.  FREE CME Credit (requires free sign-up): Link Coming Soon! References:  Agrawal S, Khazaeni B. Acetaminophen Toxicity. [Updated 2021 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441917/ Heard K. J. (2008). Acetylcysteine for acetaminophen poisoning. The New England journal of medicine, 359(3), 285–292. https://doi.org/10.1056/NEJMct0708278 Hinson JA. Mechanism of acetaminophen-induced liver toxicity. In: Kaplowitz N, DeLeve LD, eds. Drug-Induced Liver Disease. 3rd ed. London, England: Academic Press; 2013:305-330. Hon KL, Hui WF, Leung AKC. Antidotes for childhood toxidromes. Drugs in Context 2021; 10: 2020-11-4. DOI: 10.7573/dic.2020-11-4 Greene SL, Dargan PI, Jones AL. Acute poisoning: understanding 90% of cases in a nutshell. Postgrad Med J. 2005 Apr;81(954):204-16. doi: 10.1136/pgmj.2004.024794. PMID: 15811881; PMCID: PMC1743253. Lee J, Fan NC, Yao TC, Hsia SH, Lee EP, Huang JL, Wu HP. Clinical spectrum of acute poisoning in children admitted to the pediatric emergency department. Pediatr Neonatol. 2019 Feb;60(1):59-67. doi: 10.1016/j.pedneo.2018.04.001. Epub 2018 Apr 19. PMID: 29748113. Manov I, Motanis H, Frumin I, Iancu TC. Hepatotoxicity of anti-inflammatory and analgesic drugs: ultrastructural aspects. Acta Pharmacol Sin. 2006 Mar;27(3):259-72. doi: 10.1111/j.1745-7254.2006.00278.x. PMID: 16490160. Myers WC, Otto TA, Harris E, Diaco D, Moreno A. Acetaminophen overdose as a suicidal gesture: a survey of adolescents' knowledge of its potential for toxicity. J Am Acad Child Adolesc Psychiatry. 1992 Jul;31(4):686-90. doi: 10.1097/00004583-199207000-00016. PMID: 1644732. Park, B. K., Dear, J. W., & Antoine, D. J. (2015). Paracetamol (acetaminophen) poisoning. BMJ clinical evidence, 2015, 2101. Riordan M, Rylance G, Berry K. Poisoning in children 2: painkillers. Arch Dis Child. 2002 Nov;87(5):397-9. doi: 10.1136/adc.87.5.397. PMID: 12390909; PMCID: PMC1763068. Silberman J, Galuska MA, Taylor A. Activated Charcoal. [Updated 2022 Jul 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482294/ Shekunov, J., Lewis, C. P., Vande Voort, J. L., Bostwick, J. M., & Romanowicz, M. (2021). Clinical Characteristics, Outcomes, Disposition, and Acute Care of Children and Adolescents Treated for Acetaminophen Toxicity. Psychiatric Services, appi-ps. Sheridan DC, Hendrickson RG, Lin AL, Fu R, Horowitz BZ. Adolescent Suicidal Ingestion: National Trends Over a Decade. J Adolesc Health. 2017 Feb;60(2):191-195. doi: 10.1016/j.jadohealth.2016.09.012. Epub 2016 Nov 23. PMID: 27889404. Silberman J, Galuska MA, Taylor A. Activated Charcoal. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482294/ Runde TJ, Nappe TM. Salicylates Toxicity. [Updated 2021 Jul 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499879/ Yarema M, Chopra P, Sivilotti MLA, Johnson D, Nettel-Aguirre A, Bailey B, Victorino C, Gosselin S, Purssell R, Thompson M, Spyker D, Rumack B. Anaphylactoid Reactions to Intravenous N-Acetylcysteine during Treatment for Acetaminophen Poisoning. J Med Toxicol. 2018 Jun;14(2):120-127. doi: 10.1007/s13181-018-0653-9. Epub 2018 Feb 8. Erratum in: J Med Toxicol. 2018 Mar 12;: PMID: 29423816; PMCID: PMC5962465.  

Over the past two decades the number of children with obesity has continued to rise. Obesity in childhood predisposes children to both immediate and future health risk. Dr. Rebecca Yang, a general pediatrician, joins community pediatrician Dr. Ashley Miller to discuss nutrition and physical activity recommendations throughout childhood. Specifically, they will: Discuss the role nutrition and physical activity plays in pediatric obesity Educate on nutritional requirements for healthy growth and development Determine on how food insecurity plays a role in obesity Inform about recommendations for physical activity and age-appropriate guidelines Understand the barriers to physical activity Special thanks to Dr. Shreeti Kapoor who peer reviewed today's episode. FREE CME Credit (requires free sign-up): Link Coming Soon! References: • American Academy of Pediatrics. (2022, May 13). Recommended Drinks for Children Age 5 & Younger. Retrieved from Healthy Children: https://www.healthychildren.org/English/healthy-living/nutrition/Pages/Recommended-Drinks-for-Young-Children-Ages-0-5.aspx • COUNCIL ON COMMUNITY PEDIATRICS, C. O. (2015). Promoting Food Security for All Children. Pediatrics , 136(5), e1431-e1438. doi:10.1542/peds.2015-3301 • Felipe Lobelo, Natalie D. Muth, Sara Hanson, Blaise A. Nemeth, COUNCIL ON SPORTS MEDICINE AND FITNESS, SECTION ON OBESITY, Cynthia R. LaBella, M. Alison Brooks, Greg Canty, Alex B. Diamond, William Hennrikus, Kelsey Logan, Kody Moffatt, K. Brooke Pengel, Andrew R. Peterson, Paul R. Stricker, Christopher F. Bolling, Sarah Armstrong, Matthew Allen Haemer, John Rausch, Victoria Rogers, Stephanie Moore Walsh; Physical Activity Assessment and Counseling in Pediatric Clinical Settings. Pediatrics March 2020; 145 (3): e20193992. 10.1542/peds.2019-3992 • Hemmingsson E. Early Childhood Obesity Risk Factors: Socioeconomic Adversity, Family Dysfunction, Offspring Distress, and Junk Food Self-Medication. Curr Obes Rep. 2018 Jun;7(2):204-209. doi: 10.1007/s13679-018-0310-2. PMID: 29704182; PMCID: PMC5958160. • Lee JW, Lee M, Lee J, Kim YJ, Ha E, Kim HS. The Protective Effect of Exclusive Breastfeeding on Overweight/Obesity in Children with High Birth Weight. J Korean Med Sci. 2019 Mar 8;34(10):e85. doi: 10.3346/jkms.2019.34.e85. PMID: 30886551; PMCID: PMC6417996. • Maternal Diet. (2022, May 17). Retrieved from Center for Disease Control and Prevention: https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/diet-and-micronutrients/maternal-diet.html • Lobelo F, Muth ND, Hanson S, Nemeth BA; COUNCIL ON SPORTS MEDICINE AND FITNESS; SECTION ON OBESITY. Physical Activity Assessment and Counseling in Pediatric Clinical Settings. Pediatrics. 2020 Mar;145(3):e20193992. doi: 10.1542/peds.2019-3992. Epub 2020 Feb 24. PMID: 32094289. • USDA . (2022, April 22). Definitions of Food Security. Retrieved from USDA Econimic Reserach Service: https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/definitions-of-food-security/

Status Epilepticus is one of the most common pediatric neurologic emergencies and requires prompt, targeted treatment to reduce patient morbidity and mortality. On this podcast, Pediatric Critical Care Physician, Dr. Renuka Mehta, Pediatric Resident Physician, Dr. Yvonne Ibe, and medical student, Emily Austin will discuss management for status epilepticus and rapid interventions that can be potentially lifesaving—because in seizure management, time is brain.  FREE CME Credit (requires sign-in):  Link Coming Soon! Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. An additional thanks to Dr. Lorna Bell, Dr. George Hsu, and Dr. Rebecca Yang who provided editing and peer review of today's discussion. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu Remember that all content during this episode is intended for educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. Thank you for your support! References: Alldredge, B. K., Gelb, A. M., Isaacs, S. M., Corry, M. D., Allen, F., Ulrich, S., Gottwald, M. D., O'Neil, N., Neuhaus, J. M., Segal, M. R., & Lowenstein, D. H. (2001). A Comparison of Lorazepam, Diazepam, and Placebo for the Treatment of Out-of-Hospital Status Epilepticus. New England Journal of Medicine, 345(9), 631–637. https://doi.org/10.1056/NEJMoa002141  Chamberlain, J. M., Kapur, J., Shinnar, S., Elm, J., Holsti, M., Babcock, L., Rogers, A., Barsan, W., Cloyd, J., Lowenstein, D., Bleck, T. P., Conwit, R., Meinzer, C., Cock, H., Fountain, N. B., Underwood, E., Connor, J. T., Silbergleit, R., Neurological Emergencies Treatment Trials, & Pediatric Emergency Care Applied Research Network investigators. (2020). Efficacy of levetiracetam, fosphenytoin, and valproate for established status epilepticus by age group (ESETT): a double-blind, responsive-adaptive, randomised controlled trial. Lancet (London, England), 395(10231), 1217–1224. https://doi.org/10.1016/S0140-6736(20)30611-5  Chamberlain, J. M., Okada, P., Holsti, M., Mahajan, P., Brown, K. M., Vance, C., Gonzalez, V., Lichenstein, R., Stanley, R., Brousseau, D. C., Grubenhoff, J., Zemek, R., Johnson, D. W., Clemons, T. E., & Baren, J. (2014). Lorazepam vs Diazepam for Pediatric Status Epilepticus: A Randomized Clinical Trial. JAMA, 311(16), 1652. https://doi.org/10.1001/jama.2014.2625  Chen, J., Xie, L., Hu, Y., Lan, X., & Jiang, L. (2018). Nonconvulsive status epilepticus after cessation of convulsive status epilepticus in pediatric intensive care unit patients. Epilepsy & Behavior: E&B, 82, 68–73. https://doi.org/10.1016/j.yebeh.2018.02.008  Fine, A., & Wirrell, E. C. (2020). Seizures in Children. Pediatrics in Review, 41(7), 321–347. https://doi.org/10.1542/pir.2019-0134  Glauser, T., Shinnar, S., Gloss, D., Alldredge, B., Arya, R., Bainbridge, J., Bare, M., Bleck, T., Dodson, W. E., Garrity, L., Jagoda, A., Lowenstein, D., Pellock, J., Riviello, J., Sloan, E., & Treiman, D. M. (2016). Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Currents, 16(1), 48–61. https://doi.org/10.5698/1535-7597-16.1.48  Hanhan, U. A., Fiallos, M. R., & Orlowski, J. P. (2001). Status epilepticus. Pediatric Clinics of North America, 48(3), 683–694. https://doi.org/10.1016/s0031-3955(05)70334-5  Kapur, J., Elm, J., Chamberlain, J. M., Barsan, W., Cloyd, J., Lowenstein, D., Shinnar, S., Conwit, R., Meinzer, C., Cock, H., Fountain, N., Connor, J. T., Silbergleit, R., & NETT and PECARN Investigators. (2019). Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus. The New England Journal of Medicine, 381(22), 2103–2113. https://doi.org/10.1056/NEJMoa1905795  Lyttle, M. D., Rainford, N. E. A., Gamble, C., Messahel, S., Humphreys, A., Hickey, H., Woolfall, K., Roper, L., Noblet, J., Lee, E. D., Potter, S., Tate, P., Iyer, A., Evans, V., Appleton, R. E., Pereira, M., Hardwick, S., Messahel, S., Noblet, J., … Hobden, G. (2019). Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial. The Lancet, 393(10186), 2125–2134. https://doi.org/10.1016/S0140-6736(19)30724-X  Raspall‐Chaure, M., Chin, R. F. M., Neville, B. G., Bedford, H., & Scott, R. C. (2007). The Epidemiology of Convulsive Status Epilepticus in Children: A Critical Review. Epilepsia, 48(9), 1652–1663. https://doi.org/https://doi.org/10.1111/j.1528-1167.2007.01175.x  Riviello, J. J., Ashwal, S., Hirtz, D., Glauser, T., Ballaban-Gil, K., Kelley, K., Morton, L. D., Phillips, S., Sloan, E., Shinnar, S., American Academy of Neurology Subcommittee, & Practice Committee of the Child Neurology Society. (2006). Practice parameter: diagnostic assessment of the child with status epilepticus (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology, 67(9), 1542–1550. https://doi.org/10.1212/01.wnl.0000243197.05519.3d  Sánchez Fernández, I., Abend, N. S., Agadi, S., An, S., Arya, R., Brenton, J. N., Carpenter, J. L., Chapman, K. E., Gaillard, W. D., Glauser, T. A., Goodkin, H. P., Kapur, K., Mikati, M. A., Peariso, K., Ream, M., Riviello, J., Tasker, R. C., & Loddenkemper, T. (2015). Time from convulsive status epilepticus onset to anticonvulsant administration in children. Neurology, 84(23), 2304–2311. https://doi.org/10.1212/WNL.0000000000001673  Trinka, E., Cock, H., Hesdorffer, D., Rossetti, A. O., Scheffer, I. E., Shinnar, S., Shorvon, S., & Lowenstein, D. H. (2015). A definition and classification of status epilepticus--Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia, 56(10), 1515–1523. https://doi.org/10.1111/epi.13121  Welch, R. D., Nicholas, K., Durkalski-Mauldin, V. L., Lowenstein, D. H., Conwit, R., Mahajan, P. V., Lewandowski, C., Silbergleit, R., & Neurological Emergencies Treatment Trials (NETT) Network Investigators. (2015). Intramuscular midazolam versus intravenous lorazepam for the prehospital treatment of status epilepticus in the pediatric population. Epilepsia, 56(2), 254–262. https://doi.org/10.1111/epi.12905 

Amidst the battle of the mental health crisis, major depressive disorder stands out as an all-too-common reality for many children and adolescents, but the forces of science and medicine can stand against this foe. Dr. Christopher Drescher, a clinical child psychologist, joins pediatric resident Dr. Daniel Allen and medical student Vuk Lacmanovic to remove the cape from this increasingly common condition and discuss its symptoms, diagnosis, and treatment. Specifically, they will: Define major depressive disorder (MDD) and recognize the common symptoms in both children and adolescents. Formulate a differential diagnosis for patients presenting with depressive symptoms. Recognize validated screening tools for depression in both children and adolescents. Review cognitive behavioral therapy and pharmacotherapy as treatment options. Review appropriate referral to a mental health specialist. Free CME Credit (requires sign-in): https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=12493  References: Bhatia SK, Bhatia SC. Childhood and adolescent depression. Am Fam Physician. 2007 Jan 1;75(1):73-80. PMID: 17225707. Brent DA, Maalouf F. Depressive Disorders (in Childhood and Adolescence). In: Ebert MH, Leckman JF, Petrakis IL. eds. Current Diagnosis & Treatment: Psychiatry, 3e. McGraw-Hill; Accessed November 17, 2020. https://accessmedicine.mhmedical.com/content.aspx?bookid=2509§ionid=200807606 Clark MS, Jansen KL, Cloy JA. Treatment of childhood and adolescent depression. Am Fam Physician. 2012 Sep 1;86(5):442-8. PMID: 22963063. Fendrich M, Weissman MM, Warner V. Screening for depressive disorder in children and adolescents: validating the Center for Epidemiologic Studies Depression Scale for Children. Am J Epidemiol. 1990 Mar;131(3):538-51. doi: 10.1093/oxfordjournals.aje.a115529. PMID: 2301363. (PDF of CES-DC here) Forman-Hoffman V, McClure E, McKeeman J, Wood CT, Middleton JC, Skinner AC, Perrin EM, Viswanathan M. Screening for Major Depressive Disorder in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2016 Mar 1;164(5):342-9. doi: 10.7326/M15-2259. Epub 2016 Feb 9. PMID: 26857836. Hathaway EE, Walkup JT, Strawn JR. Antidepressant Treatment Duration in Pediatric Depressive and Anxiety Disorders: How Long is Long Enough? Curr Probl Pediatr Adolesc Health Care. 2018 Feb;48(2):31-39. doi: 10.1016/j.cppeds.2017.12.002. Epub 2018 Jan 12. PMID: 29337001; PMCID: PMC5828899. March JS, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, Burns B, Domino M, McNulty S, Vitiello B, Severe J. The Treatment for Adolescents With Depression Study (TADS): long-term effectiveness and safety outcomes. Arch Gen Psychiatry. 2007 Oct;64(10):1132-43. doi: 10.1001/archpsyc.64.10.1132. Erratum in: Arch Gen Psychiatry. 2008 Jan;65(1):101. PMID: 17909125. Meister R, Abbas M, Antel J, Peters T, Pan Y, Bingel U, Nestoriuc Y, Hebebrand J. Placebo response rates and potential modifiers in double-blind randomized controlled trials of second and newer generation antidepressants for major depressive disorder in children and adolescents: a systematic review and meta-regression analysis. Eur Child Adolesc Psychiatry. 2020 Mar;29(3):253-273. doi: 10.1007/s00787-018-1244-7. Epub 2018 Dec 8. PMID: 30535589; PMCID: PMC7056684. Rachel A. Zuckerbrot, Amy Cheung, Peter S. Jensen, Ruth E.K. Stein, Danielle Laraque and GLAD-PC STEERING GROUP. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management. Pediatrics March 2018, 141 (3) e20174081; DOI: https://doi.org/10.1542/peds.2017-4081 Scott K, Lewis CC, Marti CN. Trajectories of Symptom Change in the Treatment for Adolescents With Depression Study. J Am Acad Child Adolesc Psychiatry. 2019 Mar;58(3):319-328. doi: 10.1016/j.jaac.2018.07.908. Epub 2019 Jan 8. PMID: 30768414; PMCID: PMC6557284. Sharma T, Guski LS, Freund N, Gøtzsche PC. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ. 2016 Jan 27;352:i65. doi: 10.1136/bmj.i65. PMID: 26819231; PMCID: PMC4729837. Siu AL; US Preventive Services Task Force. Screening for Depression in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. Pediatrics. 2016 Mar;137(3):e20154467. doi: 10.1542/peds.2015-4467. Epub 2016 Feb 8. PMID: 26908686. Weersing VR, Brent DA, Rozenman MS, Gonzalez A, Jeffreys M, Dickerson JF, Lynch FL, Porta G, Iyengar S. Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care: A Randomized Clinical Trial. JAMA Psychiatry. 2017 Jun 1;74(6):571-578. doi: 10.1001/jamapsychiatry.2017.0429. PMID: 28423145; PMCID: PMC5539834. Weersing VR, Shamseddeen W, Garber J, Hollon SD, Clarke GN, Beardslee WR, Gladstone TR, Lynch FL, Porta G, Iyengar S, Brent DA. Prevention of Depression in At-Risk Adolescents: Predictors and Moderators of Acute Effects. J Am Acad Child Adolesc Psychiatry. 2016 Mar;55(3):219-26. doi: 10.1016/j.jaac.2015.12.015. Epub 2016 Jan 18. PMID: 26903255; PMCID: PMC4783159. Xu Y, Bai SJ, Lan XH, Qin B, Huang T, Xie P. Randomized controlled trials of serotonin-norepinephrine reuptake inhibitor in treating major depressive disorder in children and adolescents: a meta-analysis of efficacy and acceptability. Braz J Med Biol Res. 2016 May 24;49(6):e4806. doi: 10.1590/1414-431X20164806. PMID: 27240293; PMCID: PMC4897997. Zhou X, Cipriani A, Zhang Y, Cuijpers P, Hetrick SE, Weisz JR, Pu J, Giovane CD, Furukawa TA, Barth J, Coghill D, Leucht S, Yang L, Ravindran AV, Xie P. Comparative efficacy and acceptability of antidepressants, psychological interventions, and their combination for depressive disorder in children and adolescents: protocol for a network meta-analysis. BMJ Open. 2017 Aug 11;7(8):e016608. doi: 10.1136/bmjopen-2017-016608. PMID: 28801423; PMCID: PMC5629731. Zhou X, Teng T, Zhang Y, Del Giovane C, Furukawa TA, Weisz JR, Li X, Cuijpers P, Coghill D, Xiang Y, Hetrick SE, Leucht S, Qin M, Barth J, Ravindran AV, Yang L, Curry J, Fan L, Silva SG, Cipriani A, Xie P. Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: a systematic review and network meta-analysis. Lancet Psychiatry. 2020 Jul;7(7):581-601. doi: 10.1016/S2215-0366(20)30137-1. PMID: 32563306; PMCID: PMC7303954.

Lyme disease is the most common tick-borne disease in the US that can present in three different stages. Diagnosis is through a combination of a thorough history, review of systems, physical exam, as well as a two-tier serologic testing. Former Pediatric resident, Dr. James Davis, joins Associate Professor of Pediatrics, Dr. Susan Goldberg, to discuss the evaluation and management of Lyme Disease in the pediatric population. After listening to this podcast, learners should be able to: Recognize common presenting signs and symptoms of Early Localized, Early Disseminated, and Late Lyme disease from a patient history and physical examination Determine whether a patient meets clinical diagnostic criteria and, if not, which lab tests are appropriate for diagnosis of Lyme disease Appropriately prescribe the correct antibiotic choice and duration for patients, depending on variation of Lyme disease and accompanying symptoms Accurately and effectively instruct patients in prevention strategies for tick bites and Lyme disease Special thanks to Dr. Ingrid Camelo, Dr. Rebecca Yang and Dr. Jacob Eichenberger who peer reviewed today's episode. FREE CME Credit (requires free sign-up): https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=11411  References: Rodino KG, Theel ES, Pritt BS. Tick-Borne Diseases in the United States. Clin Chem. 2020 Apr 1;66(4):537-548. doi: 10.1093/clinchem/hvaa040. PMID: 32232463. Lantos PM, Rumbaugh J, Bockenstedt LK, Falck-Ytter YT, Aguero-Rosenfeld ME, Auwaerter PG, Baldwin K, Bannuru RR, Belani KK, Bowie WR, Branda JA, Clifford DB, DiMario FJ, Halperin JJ, Krause PJ, Lavergne V, Liang MH, Meissner HC, Nigrovic LE, Nocton JJJ, Osani MC, Pruitt AA, Rips J, Rosenfeld LE, Savoy ML, Sood SK, Steere AC, Strle F, Sundel R, Tsao J, Vaysbrot EE, Wormser GP, Zemel LS. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. Clin Infect Dis. 2021 Jan 23;72(1):e1-e48. doi: 10.1093/cid/ciaa1215. PMID: 33417672. Eddens T, Kaplan DJ, Anderson AJM, Nowalk AJ, Campfield BT. Insights From the Geographic Spread of the Lyme Disease Epidemic. Clin Infect Dis. 2019 Jan 18;68(3):426-434. doi: 10.1093/cid/ciy510. PMID: 29920580; PMCID: PMC6336907. Sundheim KM, Levas MN, Balamuth F, Thompson AD, Neville DN, Garro AC, Kharbanda AB, Monuteaux MC, Nigrovic LE. Seasonality of Acute Lyme Disease in Children. Trop Med Infect Dis. 2021 Nov 9;6(4):196. doi: 10.3390/tropicalmed6040196. PMID: 34842846; PMCID: PMC8628899. 2021. "Lyme Disease (Lyme Borreliosis, Borrelia burgdorferi sensu lato Infection)", Red Book: 2021–2024 Report of the Committee on Infectious Diseases, Committee on Infectious Diseases, American Academy of Pediatrics, David W. Kimberlin, MD, FAAP, Elizabeth D. Barnett, MD, FAAP, Ruth Lynfield, MD, FAAP, Mark H. Sawyer, MD, FAAP Bax CE, Clark AK, Oboite M, Treat JR. A case of disseminated Lyme disease in a child with skin of color. Pediatr Dermatol. 2021 Nov;38 Suppl 2:140-141. doi: 10.1111/pde.14770. Epub 2021 Sep 13. PMID: 34515362. Lipsett SC, Nigrovic LE. Diagnosis of Lyme disease in the pediatric acute care setting. Curr Opin Pediatr. 2016 Jun;28(3):287-93. doi: 10.1097/MOP.0000000000000339. PMID: 27138805. Shapiro ED. Borrelia burgdorferi (Lyme disease). Pediatr Rev. 2014 Dec;35(12):500-9. doi: 10.1542/pir.35-12-500. PMID: 25452659; PMCID: PMC5029759. Meissner HC, Steere AC. Management of Pediatric Lyme Disease: Updates From 2020 Lyme Guidelines. Pediatrics. 2022 Mar 1;149(3):e2021054980. doi: 10.1542/peds.2021-054980. PMID: 35229121. Bolourchi M, Silver ES, Liberman L. Advanced Heart Block in Children with Lyme Disease. Pediatr Cardiol. 2019 Mar;40(3):513-517. doi: 10.1007/s00246-018-2003-8. Epub 2018 Oct 31. PMID: 30377753. Chason ME, Monaghan M, Wang J, Cheng Y, DeBiasi RL. Symptom Resolution in Pediatric Patients With Lyme Disease. J Pediatric Infect Dis Soc. 2019 May 11;8(2):170-173. doi: 10.1093/jpids/piy067. PMID: 30060012. 2021. "Prevention of Mosquitoborne and Tickborne Infection", Red Book: 2021–2024 Report of the Committee on Infectious Diseases, Committee on Infectious Diseases, American Academy of Pediatrics, David W. Kimberlin, MD, FAAP, Elizabeth D. Barnett, MD, FAAP, Ruth Lynfield, MD, FAAP, Mark H. Sawyer, MD, FAAP Centers for Disease Control and Prevention. Preventing Tick Bites on People [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; Sept 2019 [cited 2022 March 30]. Available from: https://www.cdc.gov/lyme/prev/on_people.html

Did you know that a mild respiratory infection could be the culprit of an adverse respiratory event during a patient undergoing anesthesia? Dr. Pedro Solorzano and Dr. Ana Mavarez join Krishna Shah to discuss the evaluation and management of upper respiratory infections for patients undergoing anesthetic care. Specifically, they will:   Recall key aspects of the preoperative assessment performed by the pediatric anesthesiologist prior to perform an anesthetic.   Understand why an upper respiratory infection (URI) affects the pediatric anesthesiologist's decision to proceed or postpone a surgery or procedure requiring anesthesia or sedation.   Identify the severity of the URI symptoms that would increase the likelihood of perioperative respiratory adverse events (PRAE).   Understand the anesthetic management of a patient with an URI to minimize the risk of PRAE requiring emergent anesthesia and the timing to postpone it if the surgery is elective.  Initiate interventions to optimize the pediatric patient's respiratory status with URI prior to receiving anesthesia.   FREE CME Credit (requires free sign-up): Link coming soon! References:  Davis, Peter J. and Cladis, Franklyn, "Smith's Anesthesia for Infants and Children. 9th ed. (2017). Chapter 45. Respiratory disorders. Page 1127-1128. Von Ungern-Sternberg BS, Boda K, Chambers NA, Rebmann C, Johnson C, Sly PD, Habre W. Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study. Lancet. 2010 Sep 4;376(9743):773-83. doi: 10.1016/S0140-6736(10)61193-2. PMID: 20816545. Regli A, Becke K, von Ungern-Sternberg BS. An update on the perioperative management of children with upper respiratory tract infections. Curr Opin Anaesthesiol. 2017 Jun;30(3):362-367. doi: 10.1097/ACO.0000000000000460. PMID: 28291127. Cote C, Lerman J amd Anderson B, A Practice of Anesthesia for Infants and Children. 6th ed. (2019). Chapter 13. Essentials of pulmonology. Page 285-286. Houck, P. Anesthesia for the child with a recent upper respiratory infection. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA

Did you know that the leading cause of monocular vision loss for people of all ages can only be prevented by intervening in early childhood? Amblyopia, or decreased vision from lack of visual stimulation, affects about 3-5% of children and can lead to permanent vision loss if not treated by the age of 8. Dr. Stephanie Goei, a pediatric ophthalmologist, joins medical students Lindsay Berman and Joanne Thomas to discuss detection, diagnosis, treatment, and prognosis of amblyopia in infancy and early childhood. Specifically, they will cover how to: Recognize common history and physical exam findings associated with amblyopia. Formulate a differential diagnosis for visual deficits in children. Appreciate the importance of vision screenings as part of regular wellness visits. Understand the initial diagnostic approach to amblyopia. Recognize when to refer patients with visual deficits to a pediatric ophthalmologist. Acknowledge how the approach to treatment of amblyopia depends on the specific etiology. Special thanks to Dr. Rebecca Yang for peer reviewing this episode. FREE CME Credit (requires free sign-up):  Link Coming Soon!  References:  McConaghy JR, McGuirk R. Amblyopia: Detection and Treatment. Am Fam Physician. 2019 Dec 15;100(12):745-750. PMID: 31845774. Holmes JM, Lazar EL, Melia BM, et al.; Pediatric Eye Disease Investigator Group. Effect of age on response to amblyopia treatment in children. Arch Ophthalmol. 2011;129(11):1451–1457. American Academy of Pediatrics. Policy statement. Visual system assessment in infants, children, and young adults by pediatricians. January 2016. Accessed December 16, 2018. http://pediatrics.aappublications.org/content/137/1/e20153596 American Academy of Ophthalmology. Amblyopia PPP - 2017. November 2017. Accessed December 16, 2018. https://www.aao.org/preferred-practice-pattern/amblyopia-ppp-2017 Blair K, Cibis G, Gulani AC. Amblyopia. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430890/

Did you know that menstrual abnormalities affect up to 75% of adolescent females and account for a large portion of visits to the doctor as well as for missed school? Dr. Nirupma Sharma, a pediatric hospitalist with prior training in obstetrics and gynecology, joins medical students Mary Beth Mahaffey and Lauren Brewer to discuss evaluation of a common menstrual abnormality, amenorrhea, in a female adolescent patient. Specifically, they will: Define amenorrhea and distinguish between primary and secondary causes. Discuss important aspects of the history and physical exam, as well as interpretation of relevant labs. Review the presentation and initial diagnostic workup of the female athlete triad, also known as functional hypothalamic amenorrhea. Overall, provide guidance for pediatricians in recognizing disorders related to amenorrhea to allow for early detection and promotion of proper treatment and referral when necessary. Special thanks to Dr. Erin Latif and Dr. Rebecca Yang for peer reviewing this episode. FREE CME Credit (requires free sign-up):  Link Coming Soon!  References:  https://www.aafp.org/afp/2013/0601/p781.html https://www.ncbi.nlm.nih.gov/books/NBK279144/ https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2015/12/menstruation-in-girls-and-adolescents-using-the-menstrual-cycle-as-a-vital-sign https://pedclerk.uchicago.edu/sites/pedclerk.uchicago.edu/files/uploads/035070025.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435916/ https://www.ncbi.nlm.nih.gov/books/NBK279144/ https://pubmed.ncbi.nlm.nih.gov/6379175/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6188290/ https://www.aafp.org/afp/2000/0601/p3357.html https://pediatrics.aappublications.org/content/138/2/e20160922 https://www.acog.org/womens-health/faqs/dysmenorrhea-painful-periods https://pubmed.ncbi.nlm.nih.gov/27423183/ https://pubmed.ncbi.nlm.nih.gov/19609045/ https://www.ncbi.nlm.nih.gov/books/NBK554469/ https://pubmed.ncbi.nlm.nih.gov/32119508/ https://www.ccjm.org/content/85/4/313.long https://www.ncbi.nlm.nih.gov/books/NBK430787/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388220/#b6-oajsm-8-085 https://bjsm.bmj.com/content/48/4/289.long 

Adolescents represent a portion of the fastest growing demographic for development of sexually transmitted infection. Studies have found that STIs have some of the highest rates in individuals aged 15-24, and 20% of new HIV diagnoses occur in people aged 13-24. Pre-exposure prophylaxis (PrEP) is medicine people at risk for HIV take to prevent getting HIV from sex or injection drug use and is an effective tool to dramatically decrease the risk of HIV acquisition in at-risk youth. Dr. Cheryl Newman, a board certified infectious disease specialist joins medical students Patrice Collins and Elise Liu to discuss PrEP for HIV prevention in the adolescent population.  After listening to this podcast, learners should be able to: Learn the approach to sexual health screening in adolescents. Understand the risks of HIV exposure in adolescents. Define PrEP and how it works. Understand the requirements for starting PrEP, including demographics and preliminary testing. Explain the federal and/or state laws that govern the prescription of HIV prevention medicine for adolescents. FREE CME Credit (requires free sign-up):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=11407    References:  Agwu A. Sexuality, Sexual Health, and Sexually Transmitted Infections in Adolescents and Young Adults. Top Antivir Med. 2020;28(2):459-462. Centers for Disease Control and Prevention. Prep for HIV Prevention in the U.S. Accessed Apr 15, 2022. https://www.cdc.gov/nchhstp/newsroom/fact-sheets/hiv/PrEP-for-hiv-prevention-in-the-US-factsheet.html Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV. National Institute of Health. Updated Jun 03, 2021. Accessed Apr 15, 2022. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/adolescents-and-young-adults-hiv#:~:text=Preventive%20Measures%20and%20Supporting%20Long,%2C%20osteoporosis%2C%20and%20neurocognitive%20impairment. Hsu K, Rakhmanina N. Adolescents and Young Adults: The Pediatrician's Role in HIV Testing and Pre- and Postexposure HIV Prophylaxis. Pediatrics. 2022; 149(1):e2021055207 Hosek S, Henry-Reid L. PrEP and Adolescents: The Role of Providers in Ending the AIDS Epidemic. January 2020; 145 (1): e20191743. 10.1542/peds.2019-1743 Truvada Website. https://www.truvada.com/truvada-safety/clinical-studies. Accessed Apr 15, 2022. Descovy Website. https://www.descovy.com/#isi. Accessed Apr 15, 2022. FDA Approves First Injectable Treatment for HIV Pre-Exposure Prevention. Dec 20, 2021. Accessed Apr 15, 2022. https://www.fda.gov/news-events/press-announcements/fda-approves-first-injectable-treatment-hiv-pre-exposure-prevention Landovitz RJ, Donnell D, Clement ME, et al. Cabotegravir for HIV Preention in Cisgender Men and Transgender Women. N Engl J Med. August 2021; 385:595-608. https://www.nejm.org/doi/full/10.1056/NEJMoa2101016 Highleyman L. US approves injectable cabotegravir for PrEP. Accessed Apr 15, 2022. https://www.aidsmap.com/news/dec-2021/us-approves-injectable-cabotegravir-prep Trial results reveal that long-acting injectable cabotegravir as PrEP is highly effective in preventing HIV acquisition in women. Nov 9, 2020. Accessed Apr 15, 2022. https://www.who.int/news/item/09-11-2020-trial-results-reveal-that-long-acting-injectable-cabotegravir-as-prep-is-highly-effective-in-preventing-hiv-acquisition-in-women FDA approves second drug to prevent HIV infection as part of ongoing efforts to end the HIV epidemic. Oct 3, 2019. Accessed Apr 15, 2022. https://www.fda.gov/news-events/press-announcements/fda-approves-second-drug-prevent-hiv-infection-part-ongoing-efforts-end-hiv-epidemic#:~:text=The%20U.S.%20Food%20and%20Drug,who%20have%20receptive%20vaginal%20sex Centers for Disease Control and Prevention. Pre-exposure Prophylaxis (PrEP). Accessed Apr 15, 2022. https://www.cdc.gov/hiv/clinicians/prevention/prep.html#:~:text=For%20oral%20PrEP&text=Assess%20creatinine%20clearance%20once%20every,creatinine%20clearance%20every%206%20months Tanner M, Miele P, et al. Preexposure Prophylaxis for Prevention of HIV Acquisition Among Adolescents: Clinical Considerations, 2020. CDC Recommendations and Reports. 2020; 69(3):1-12 Cowan EA, McGowan JP, Fine SM, et al. Diagnosis and Management of Acute HIV [Internet]. Baltimore (MD): Johns Hopkins University; 2021 Jul. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563020/ Sax PE. Screening and diagnostic testing for HIV infection. In: Post TW, ed. UpToDate; 2022. Accessed May 15, 2022. https://www.uptodate.com/contents/screening-and-diagnostic-testing-for-hiv-infection?search=hiv%20screening&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Jaspard M, Le Moal G, Saberan-Roncato M, Plainchamp D, Langlois A, Camps P, Guigon A, Hocqueloux L, Prazuck T. Finger-stick whole blood HIV-1/-2 home-use tests are more sensitive than oral fluid-based in-home HIV tests. PLoS One. 2014 Jun 27;9(6):e101148. doi: 10.1371/journal.pone.0101148. PMID: 24971842; PMCID: PMC4074152. NBC News. 2022. PrEP, the HIV prevention pill, must now be totally free under almost all insurance plans. [online] Available at: [Accessed 19 May 2022].

Vaccine development is considered one of the greatest achievements of public health and medical science with millions of lives saved worldwide from many once-deadly infectious diseases.  Fortunately, most parents readily accept all vaccines recommended by the American Academy of Pediatrics (AAP).  However, vaccine hesitancy is becoming increasingly prevalent. Pediatric Resident, Dr. Caroline Fu, joins Associate Professor of Pediatrics at MCG, Dr. Donna Moore, to discuss childhood vaccine hesitancy.  After listening to this podcast, learners should be able to: 1. Recognize the public health concerns of childhood vaccination refusal and delays. 2. Understand common objections and concerns about vaccines and know how to dispel misconceptions. 3. Utilize communication strategies for counseling vaccine hesitant parents. 4. Know how to access reputable resources to provide parents who would like additional resources. 5. Explain the few true medical contraindications to vaccines vs. religious or philosophical objections. 6. Review tips on how to approach parents who continue to refuse vaccines despite extensive counseling. FREE CME Credit (requires free sign-up):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=11406  References:  Wolfe, RM and Sharp, LK.  Anti-Vaccinationists Past and Present.  BMJ.  2002; 325:430.  AAP COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE, AAP COMMITTEE ON INFECTIOUS DISEASE, AAP COMMITTEE ON STATE GOVERNMENT AFFAIRS, AAP COUNCIL ON SCHOOL HEALTH, AAP SECTION ON ADMINISTRATION AND PRACTICE MANAGEMENT.  Medical versus Nonmedical Immunization Exemptions for Child Care and School Attendance.  2016; 138 (3): e20162145  Edwards KM, Hackell JM, AAP THE COMMITTEE ON INFECTIOUS DISEASES, THE COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE.  Countering Vaccine Hesitancy.  Pediatrics.  2016; 138(3): e20162146  Natbony, J and Genies, M. Vaccine Hesitancy and Refusal in Brief.   Pediatrics in Review.  2016; 40.1(22-3)  Smith, M.  Vaccine Safety: Medical Contraindications, Myths, and Risk Communication.  Pediatrics in Review.  2015; 36:6 (227-236).  Healy, MC and Pickering, LK.  How to Communicate with Vaccine-Hesitant Parents.  2011; 127:S127-S133.  McKee, C and Bohannon, K.  Exploring the Reasons Behind Parental Refusal of Vaccines.  Journal of Pediatric Pharmacology and Therapeutics.  2016; 1:2 (104-9).  Wombwell E, Fangman MT, Yoder AK, and Spero DL.  Religious Barriers to Measles Vaccination.  Journal of Community Health.  2015; 40:597-604.  Singh, K and Mehta, S.  The clinical development process for a novel preventative vaccine: An overview.  Journal of Postgraduate Medicine. 2016; 62(1): 4-11.    Girotto, J.  What does full FDA Approval Mean for a Vaccine already authorized for emergency use?  UConn Today.  August 19, 2021. https://today.uconn.edu/2021/08/what-does-full-fda-approval-mean-for-a-vaccine-already-authorized-for-emergency-use/  Quinn SC, Jamison AM, Freimuth V.  Communicating effectively about emergency use authorization and vaccines in the COVID-19 pandemic.  Am J Public Health.  2021; 111(3):355-358.  JD Grabstein. What the World Teaches, Applied to Vaccines and Immunoglobulins. Vaccine.  2013 April 12;31(16):2011-23.doi: 10.1016/j.vaccine.2013.02.026. Epub 2013 Feb 26.  World Health Organization. Ten health issues who will tackle this year. 2019.  https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019 Resources for parents and providers  CDC provider resources for conversation with vaccine hesitant parents: https://www.cdc.gov/vaccines/hcp/conversations/index.html https://www.cdc.gov/vaccines/parents/index.html (CDC vaccines for parents resource)  https://www.cdc.gov/vaccines/pubs/pinkbook/index.html (PinkBook CDC)  https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/hepb.html (Advisory Committee on Immunization Practices; contraindications and precautions for vaccines)  https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/thimerosal-and-vaccines#cstat https://www.chop.edu/centers-programs/vaccine-education-center/vaccine-ingredients CHOP vaccine ingredients   https://www.chop.edu/centers-programs/vaccine-education-center/resources/vaccine-and-vaccine-safety-related-qa-sheets CHOP Vaccine safety q and a  https://www.vaccinesafety.edu/Religion.htm https://downloads.aap.org/DOPCSP/SOID_RTV_form_01-2019_English.pdf AAP Refusal to Vaccinate Form - English  https://downloads.aap.org/DOPCSP/SOID_RTV_form_01-2019_Spanish.pdf AAP Refusal to Vaccinate Form - Spanish  https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html COVID vaccine tracker (details the vaccine trials and approval process).   

According to the US Department of Health and Human Services, in 2018, there were 7.8 million children evaluated nationally for child abuse. About 1700 of the cases were associated with fatalities. Did you know that the younger the child, the more likely for abuse to result in death?  For this reason, it is the responsibility of the entire healthcare team and anyone who works with children to know what the signs of child abuse are. Dr. Kevin Allen, a Pediatric Emergency Physician and Medical Director of the Child Protection Team, joins Resident Dr. Chaitanya Sambangi and Medical Student Clara Horner to discuss non-accidental trauma, including covering the following: Understand the epidemiology surrounding non-accidental trauma. Recognize common red flags in the history that would indicate concern for child abuse. Identify physical exam features that would raise suspicion for NAT Recognize potential mimics of non-accidental trauma in children. Select appropriate labs and imaging when NAT is suspected. Understand the role and responsibilities of a mandated reporter. Understand what happens after suspected NAT is reported. Identify how the COVID-19 pandemic may be impacting NAT. Recognize methods for pediatricians to help prevent maltreatment. FREE CME Credit (requires sign-in):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=11405   Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. An additional thanks to Dr. Lorna Bell, Dr. George Hsu, and Dr. Rebecca Yang who provided editing and peer review of today's discussion. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu Remember that all content during this episode is intended for educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. Thank you for your support! References: 1. https://www.acepnow.com/article/spotting-and-reporting-child-neglect-cases/?singlepage=1 2. Pierce MC, Kaczor K, Lorenz DJ, et al. Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics. JAMA Netw Open. 2021;4(4):e215832. doi:10.1001/jamanetworkopen.2021.5832 3. Letson  MM, Cooper  JN, Deans  KJ,  et al.  Prior opportunities to identify abuse in children with abusive head trauma.   Child Abuse Negl. 2016;60:36-45. doi:10.1016/j.chiabu.2016.09.001 4. https://www.aap.org/en/patient-care/child-abuse-and-neglect/  (Policy statements/resources) 5. https://www.ncedsv.org/resources/healthcare-toolkit/pediatric-health-resources/ 6.https://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/Child_Abuse_Resource_Center/Home.aspx 7. https://www.caresnw.org/national-resources/ 8. Other resources- Rape Crisis- https://www.rainn.org/state-resources

Did you know that there are an estimated 5 million human or animal bite wounds occur annually in the United States? Dog bite wounds are the most common, and infections rates can be as high as 50% for cat bite wounds. Today, pediatric resident, Dr. Jack Noel, joins pediatric emergency medicine physician, Dr. Jim Wilde, and pediatric emergency medicine fellow, Dr. Inna Kaminecki, to explore the common management strategies and potential pitfalls to avoid. Specifically, we will be covering the following: 1. Recognize common history and physical exam findings associated with animal and human bites. 2. Be able to recognize important pathogenic bacteria associated with animal and human bites.  3. Understand the initial diagnostic approach to animal and human bites. 4. Initiate appropriate prophylaxis in animal and human bites to prevent tetanus, rabies, and wound infection.  5. Initiate appropriate management of bite wounds.  6. Create an appropriate disposition for patient with bite wounds. FREE CME Credit (requires sign-in):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=11167  Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu Remember that all content during this episode is intended for educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. Thank you for your support! References: 1. Bula-Rudas FJ, Olcott JL. Human and Animal Bites. Pediatr Rev. 2018 Oct;39(10):490-500.  2. Edens MA, Michel JA, Jones N. Mammalian Bites In The Emergency Department: Recommendations For Wound Closure, Antibiotics, And Postexposure Prophylaxis. Emerg Med Pract. 2016 Apr;18(4):1-20.  3. Centers for Disease Control and Prevention (CDC). Nonfatal dog bite-related injuries treated in hospital emergency departments-United States, 2001. MMWR Morb Mortal Wkly Rep. 2003 Jul 4;52(26):605-610.  4. Liang JL, Tiwari T, Moro P, Messonnier NE, Reingold A, Sawyer M, Clark TA. Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2018 Apr 27;67(2):1-44.  5. Havers FP, Moro PL, Hunter P, Hariri S, Bernstein H. Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2019. MMWR Morb Mortal Wkly Rep. 2020 Jan 24;69(3):77-83. 6.  American Academy of Pediatrics. Bite wounds. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018-2021 Report of the Committee on Infectious Diseases. 31st ed. Elk Grove Village, IL: American Academy of Pediatrics; 2018:189–195.  7. American Academy of Pediatrics. Rabies. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018-2021 Report of the Committee on Infectious Diseases. 31st ed. Elk Grove Village, IL: American Academy of Pediatrics; 2018:673-680. 8. American Academy of Pediatrics. Tetanus. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018-2021 Report of the Committee on Infectious Diseases. 31st ed. Elk Grove Village, IL: American Academy of Pediatrics; 2018:793-798. 9. S. Ramgopal, M.L. Macy, US estimates for dog bite injuries presenting to emergency departments, Public Health, Volume 196, 2021,Pages 1-3, ISSN 0033-3506 https://doi.org/10.1016/j.puhe.2021.04.028.

The commonly seen diagnosis of Failure to Thrive is an easily preventable disease state but when ignored, it can lead to serious complications. Dr. Rebecca Yang and Dr. Kathryn McLeod joins medical student Sheenu Chirackel to discuss the evaluation and management for failure to thrive in childhood. Listen to this week's podcast to: Recognize common history and physical exam findings associated with Failure to Thrive Formulate a differential diagnosis for FTT Identify potential risk factors and causes for FTT Initiate appropriate therapy for FTT Special thanks to Dr. Rebecca Pierce for peer reviewing this episode FREE CME Credit (requires sign-in):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=10784   Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. Thank you for your support! References: Berwick DM, Levy JC, Kleinerman R. Failure to thrive: diagnostic yield of hospitalisation. Arch Dis Child. 1982;57(5):347-351. doi:10.1136/adc.57.5.347 Bithoney WG, Van Sciver MM, Foster S, Corso S, Tentindo C. Parental stress and growth outcome in growth-deficient children. Pediatrics. 1995 Oct;96(4 Pt 1):707-11. PMID: 7567335. O'Brien LM, Heycock EG, Hanna M, Jones PW, Cox JL. Postnatal depression and faltering growth: a community study. Pediatrics. 2004 May;113(5):1242-7. doi: 10.1542/peds.113.5.1242. PMID: 15121936. Danner E, Joeckel R, Michalak S, Phillips S, Goday PS. Weight velocity in infants and children. Nutr Clin Pract. 2009 Feb-Mar;24(1):76-9. doi: 10.1177/0884533608329663. PMID: 19244151. Homan GJ. Failure to Thrive: A Practical Guide. Am Fam Physician. 2016 Aug 15;94(4):295-9. PMID: 27548594. Estrem HH, Pados BF, Park J, Knafl KA, Thoyre SM. Feeding problems in infancy and early childhood: evolutionary concept analysis. J Adv Nurs. 2017 Jan;73(1):56-70. doi: 10.1111/jan.13140. Epub 2016 Sep 23. PMID: 27601073. Larson-Nath, C., & Biank, V. F. (2016). Clinical review of failure to thrive in pediatric patients.Pediatric Annals, 45(2), e46-49. doi:http://dx.doi.org/10.3928/00904481-20160114-01 Cole, S. Z., & Lanham, J. S. (2011). Failure to thrive: An update. American Family Physician, 83(7), 829-834. Retrieved from https://www.proquest.com/scholarly-journals/failure-thrive-update/docview/2454417000/se-2?accountid=12365

Children frequently are brought to the emergency room for difficulty walking. In some cases, the cause is easily identified, but in others, the cause can be a sign of a more serious condition.  Dr. George Hsu, a Pediatric Emergency Physician, joins Dr. Ohmed Khilji and Pediatric Resident Kristen Schmidbauer to discuss the evaluation and management of children presenting with a limp. Specifically, they will: Review common history and physical exam findings associated with conditions causing children to limp Discuss initial diagnostic approach, as well as selecting appropriate labs, imaging, and treatment options Diagnoses discussed: septic arthritis, toddler's fracture, osteomyelitis, Perthes disease, malignancy, non-accidental trauma, slipped capital femoral epiphysis, transient synovitis and more Special thanks to Dr. Rebecca Yang and Dr. Melissa Allen for peer reviewing this episode. FREE CME Credit (requires sign-in):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=10783 Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu Remember that all content during this episode is intended for educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. Thank you for your support! References: Flynn JM, Widmann RF. The limping child: evaluation and diagnosis. J Am Acad Orthop Surg. 2001; 9(2): 89-98 The Limping Child. Martin J. Herman, Melissa Martinek. Pediatrics in Review May 2015, 36 (5) 184-197; DOI:1542/pir.36-5-184 Herring  J, Birch  J. The limping child. In: Herring J, ed. Pediatric Orthopaedics. 5th ed. Philadelphia, PA: Saunders; 2014:79–89

Welcome to the MCG Pediatric Podcast! Dr. April Hartman, an associate professor of Pediatrics and the Division Chief of General Pediatric and Adolescent Medicine at the Children's Hospital of Georgia, is joined by Medical Student, Kayla Cooper to discuss pertinent topics surrounding individuals living with Autism with a pediatric lens. Specifically, they will: Define, Explain the prevalence of, and discuss clinical symptoms of autism spectrum disorder Explain the diagnostic evaluation of autism spectrum disorder Discuss the screening and surveillance of autism spectrum disorder Evaluate the management of co-occurring conditions with autism spectrum disorder Define Current Interventions for patients within this community Explain advocacy and partnership with families of patients FREE CME Credit (requires sign-in):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=9857 Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. Thank you for your support! References: Evans B. How autism became autism: The radical transformation of a central concept of child development in Britain. Hist Human Sci. 2013;26(3):3-31. doi:10.1177/0952695113484320 Identification, Evaluation, and Management of Children with Autism Spectrum Disorder. Susan L. Hyman, Susan E. Levy, Scott M. Myers, COUNCIL ON CHILDREN WITH DISABILITIES, SECTION ON DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS. Pediatrics Jan 2020, 145 (1) e20193447; DOI: 10.1542/peds.2019-3447 https://www.cdc.gov/ncbddd/autism/data.html. Accessed on 12/23/20 The American Academy of Pediatrics (AAP). Identifying and Caring for Children with Autism Spectrum Disorder A course for Pediatric Clinicians. [Online Course]. Pedialink. http://asd.pedialink.courses.aap.org/course/ https://www.cdc.gov/ncbddd/autism/addm-community-report/documents/addm-community-report-2020-h.pdf Timing of the Diagnosis of Autism in African American Children. John N. Constantino, Anna M. Abbacchi, Celine Saulnier, Cheryl Klaiman, David S. Mandell, Yi Zhang, Zoe Hawks, Julianna Bates, Ami Klin, Paul Shattuck, Sophie Molholm, Robert Fitzgerald, Anne Roux, Jennifer K. Lowe, Daniel H. Geschwind. Pediatrics Sep 2020, 146 (3) e20193629; DOI: 10.1542/peds.2019-3629

Lead toxicity continues to be a major public health concern in the United States. Children are particularly vulnerable to the potential toxicity of lead. Nicole Bisel, a medical student at the Medical College of Georgia is joined by pediatricians Dr. Tyrone Bristol and Dr. Rebecca Yang to to discuss the risk, evaluation and management of lead toxicity in children. Specifically, they will: Why lead toxicity continues to be an issue today Discuss sources of how humans are exposed to lead Review Risk Factors & Consequences of lead toxicity And finally discuss screening, management, and treatment for children with lead toxicity FREE CME Credit (requires sign-in):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=9855 Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu Remember that all content during this episode is intended for educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. Thank you for your support! References: American Academy of Pediatrics. Council of Environmental Health. Prevention of Childhood Lead Toxicity. Pediatrics. 2016;38(1)e20161493 – August 01, 2017 https://pediatrics.aappublications.org/content/138/1/e20161493 American Academy of Pediatrics. Childhood Lead Exposure Infographic. In: American Academy of Pediatrics Health Initiatives Lead Exposure and Lead Poisoning. American Academy of Pediatrics Website. https://www.aap.org/en-us/ImagesGen/Lead_infographic.jpg. Accessed February 6, 2021. PEHSU: Pediatric Environmental Health Specialty Units. Lead and Drinking Water: Information for Health Professionals Across the United States. American Academy of Pediatrics Website. https://www.pehsu.net/_Library/facts/LeadandDrinkingWater_62116_final.pdf. Accessed February 6, 2021. American Academy of Pediatrics. Lead Exposure in Children. American Academy of Pediatrics Website. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/lead-exposure/Pages/Lead-Exposure-in-Children.aspx. Accessed February 6, 2021. Centers for Disease Control and Prevention. Childhood Lead Poisoning Prevention. Childhood Lead Poisoning Prevention Program Website. https://www.cdc.gov/nceh/lead/. Accessed February 6, 2021. Mayans L. Lead Poisoning in Children. American Family Physician. 2019; 100(1):24-30. https://www.aafp.org/afp/2019/0701/p24.html. Accessed February 13, 2021. Hanna-Attisha M, LaChance J, Sadler RC, Schnepp AC. Elevated Blood Lead Levels in Children Associated With the Flint Drinking Water Crisis: A Spatial Analysis of Risk and Public Health Response. American Journal of Public Health. 2016; 106(2): 283-290. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985856/#__ffn_sectitle. Accessed February 13, 2021. Council on Environmental Health. Prevention of Childhood Lead Toxicity. Pediatrics. 2016; 138(1):e20161493. https://pediatrics.aappublications.org/content/138/1/e20161493%20. Accessed February 13, 2021. Sanders T, Liu Y, Buchner V, Tchounwou PB. Neurotoxic Effects and Biomarkers of Lead Exposure: A Review. Rev Environ Health. 2009; 24(1): 15-45. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2858639/#__ffn_sectitle. Accessed February 13, 2021. American Academy of Pediatrics. Detection of Lead Poisoning. American Academy of Pediatrics Website. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/lead-exposure/Pages/Detection-of-Lead-Poisoning.aspx. Accessed March 7, 2021 American Academy of Pediatrics. Treatment of Lead Poisoning. American Academy of Pediatrics Website. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/lead-exposure/Pages/Treatment-of-Lead-Poisoning.aspx. Accessed March 7, 2021. Zahran S, McElmurry SP, Sadler RC. Four Phases of Flint Water Crisis: Evidence from Blood Lead Levels in Children. Environ Res. 2017; 157: 160-172. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5538017/. Accessed February 13, 2021. https://www.cdc.gov/nceh/lead/advisory/acclpp/actions-blls.htm. Accessed March 14, 2021. https://www.cdc.gov/nceh/lead/advisory/acclpp/actions-blls.htm. . Accessed Nov 14, 2021.  

We are back with more information about Sickle Cell Disease with emphasis on adolescent health. Dr. Nnenna Badamosi, a Pediatric Hematologist, joins Dr. Zachary Hodges and Second Year Medical Student Kayla Cooper to discuss the important aspects that every pediatrician should know when treating patients with Sickle cell disease. Specifically, they will: Recognize the important complications of SCD in adolescence & young adulthood. Generally, recall the required routine health maintenance for adolescents and young adults with SCD. Recognize the complexity of chronic pain in SCD and the necessity for multidisciplinary care. Identify risk factors associated with increased health care utilization and mortality in young adults with SCD. Understand the goals of a structured transition process for young adults with SCD. Recognize the quality indicators of a successful transition of care in SCD. FREE CME Credit (requires sign-in):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=9854 Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. Thank you for your support! References: Field, Joshua J. “Five lessons learned about long-term pain management in adults with sickle cell disease.”  American Society of Hematology. Education Programvol. 2017,1 (2017): 406-411. doi:10.1182/asheducation-2017.1.406 https://www.gottransition.org/six-core-elements/

We all have heard of Sickle cell disease, but have we discussed care across the lifespan for patients with this condition? Dr. Nnenna Badamosi, a Pediatric Hematologist, joins Dr. Zachary Hodges and Second Year Medical Student Kayla Cooper to discuss the important aspects that every pediatrician should know when treating patients with Sickle cell disease. Specifically, they will: Recognize newborn screening results that are consistent with sickle cell disease Recognize the need for additional routine vaccines for meningococcal and streptococcal pneumonia disease in children with sickle cell disease. Understand the indications and initiate appropriate antibiotic prophylaxis for infants and young children with sickle cell disease. Recognize the risk of early acute complications of sickle cell disease including dactylitis, splenic sequestration and invasive bacterial infections Recognize the benefits and risks of disease-modifying therapy with hydroxyurea early in childhood. Recognize the importance of primary stroke prevention with transcranial doppler screening and treatment with chronic transfusions. Recognize the importance of screening for end organ disease including cardiac dysfunction, retinopathy and kidney disease. Peer Reviewed by MCG Pediatric Podcast Committee FREE CME Credit (requires sign-in):  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=9853 Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. Thanks again for your support!   References: Minkovitz, Cynthia S et al. “Newborn Screening Programs and Sickle Cell Disease: A Public Health Services and Systems Approach.” American journal of preventive medicine 51,1 Suppl 1 (2016): S39-47. doi:10.1016/j.amepre.2016.02.019 https://www.nhlbi.nih.gov/health-topics/evidence-based-management-sickle-cell-disease Cober MP, Phelps SJ. Penicillin prophylaxis in children with sickle cell disease. J Pediatr Pharmacol Ther. 2010;15(3):152-159. Adams RJ, McKie VC, Hsu L, Files B, Vichinsky E, Pegelow C, Abboud M, Gallagher D, Kutlar A, Nichols FT, Bonds DR, Brambilla D. Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. N Engl J Med. 1998 Jul 2;339(1):5-11. doi: 10.1056/NEJM199807023390102. PMID: 9647873.

We are living in a technology saturated world as we rely on smart devices for virtual learning, entertainment, completing work, and connecting with others. But how much is too much for our children? What are risks and benefits of technology use for children? And what is the pediatrician's role in helping to educate their patients and parents? Join Dr. Jacob Eichenberger and Dr. Kathryn Peralta as they discuss the impact of technology use on children and how pediatricians can counsel families on appropriate use to ensure healthy development and wellbeing. Learning Objectives: Review the epidemiology of screen media use in children and adolescents Identify age-appropriate types and duration of use for various technology Discuss risk factors for excessive or problematic use in children and what physical and emotional outcomes may be associated with excessive media use. Discuss impact of social media, cyberbullying, and risks of exploitation of children from technology use. Identify benefits of screen media as well as tips to help parents navigate this complex topic Peer Reviewers: Dr. Rebecca Yang, Dr. Zachary Hodges Free CME Credit:  https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=8632 References: Rideout, V., & Robb, M. B. (2020). The Common Sense census: Media use by kids age zero to eight, 2020. San Francisco, CA: Common Sense Media. Rideout, V., and Robb, M. B. (2019). The Common Sense census: Media use by tweens and teens, 2019. San Francisco, CA: Common Sense Media. Rideout, V., Foehr, U., Roberts, D., GENERATION M2 Media in the Lives of 8- to 18-Year-Olds. A Kaiser Family Foundation Study JANUARY 2010. Reid Chassiakos Y,  Radesky  J,  Christakis  D,  et  ,  AAP  COUNCIL  ON  COMMUNICATIONS  AND  MEDIA.  Children and Adolescents and Digital Media. Pediatrics. 2016;138(5):e20162593 Hoge, E., Bickham, D., Cantor, J. Digital Media, Anxiety, and Depression in Children. Pediatrics Volume 140, number s2, November 2017:e20161758 AAP COUNCIL ON COMMUNICATIONS AND MEDIA. Media and Young Minds. Pediatrics. 2016;138(5):e20162591 Radesky J, Chassiakos Y, LR, Ameenuddin N, et al. AAP COUNCIL ON  COMMUNICATION  AND    Digital Advertising to Children. Pediatrics. 2020;146(1):e20201681 Technology and Interactive Media as Tools in Early Childhood Programs Serving Children from Birth through Age 8. (2012, January). Retrieved from https://www.naeyc.org/sites/default/files/globally-shared/downloads/PDFs/resources/topics/PS_technology_WEB.pdf Jennifer S. Saul, Rachel F. Rodgers, Adolescent Eating Disorder Risk and the Online World, Child and Adolescent Psychiatric Clinics of North America, Volume 27, Issue 2, 2018, Pages 221-228, Jasmine Fardouly, Lenny R. Vartanian, Social Media and Body Image Concerns: Current Research and Future Directions, Current Opinion in Psychology, Volume 9, 2016, Pages 1-5 Saunders, J., and Eaton, A. Snaps, Selfies, and Shares: How Three Popular Social Media Platforms Contribute to the Sociocultural Model of Disordered Eating Among Young Women. CYBERPSYCHOLOGY, BEHAVIOR, AND SOCIAL NETWORKING Volume 21, Number 6, 2018 Hill, D. Social Media: Anticipatory Guidance. Pediatrics In Review Volume 41, Number 3. March 2020 Pages 112-117. D'Angelo, J; Moreno, M. Screening for Problematic Internet Use. PEDIATRICS Volume 145, number s2, May 2020:e20192056F Steinberg, S. Sharenting: Children's Privacy in the Age of Social Media. University of Florida Levin College of Law Legal Studies Research Paper Series Paper No. 16-41 Richdel, M. (2021, January 16). Children's Screen Time Has Soared in the Pandemic, Alarming Parents and Researchers. The New York Times. Haelle, T. (2016, October 28). Do Parents Invade Children's Privacy When They Post Photos Online? NPR Maheshwari, S. (2017, November 4). On YouTube Kids, Startling Videos Slip Past Filters. The New York Times The Impact of Social Media on Children, Adolescents, and Families. Gwenn Schurgin O'Keeffe, Kathleen Clarke-Pearson, Council on Communications and Media. Pediatrics Apr 2011, 127 (4) 800-804; DOI:1542/peds.2011-0054 https://www.stopbullying.gov/. Accessed 6/19/21. Google Resources For Providers Clinic for Interactive Media and Internet Disorders (CIMAID)at Boston Children's Hospital Digital Wellness Lab (Contains Screening Tools and Anticipatory Guidance) https://digitalwellnesslab.org/cimaid/clinician-toolkit/ Internet Addiction Assessment https://psychology-tools.com/test/internet-addiction-assessment Problematic and Risky Internet Use Screening Scale (PRIUSS) accessed from https://doi.org/10.1016/j.acap.2015.07.001 Resources for Parents Reviews of Digital Media. org Creating a Digital Media Plan: https://www.healthychildren.org/English/news/Pages/Managing-Media-We-Need-a-Plan.aspx

Palliative Care with Dr. Sharon Beall Free CME Credit:  Click Here Participants: Rachel Vaizer, MD Sharon Beall, MD Zachary Hodges, MD Peer review by the MCG Pediatric Podcast Committee About our guest: Dr. Sharon Beall is an Associate Professor of Pediatrics at the Medical College of Georgia and the medical director for the Children's Hospital of Georgia palliative care and hospice program. Learning Objectives: After listening to this podcast, learners should be able to: Understand the value of palliative care as well as an overview of palliative care principles and practices. Recognize the need for expertise in the assessment and treatment of patient symptom burden, functional status and quality of life. Recognize the burden of serious illness and the role of palliative care in screening, assessing and treating psychological and psychiatric illnesses. Recognize the social limitations in caring for the seriously ill and have a guide for screening for access to social support, food, housing, transportation and adaptive equipment. Recognize the importance of spiritual and cultural beliefs in patient and family decision making. Understand the importance of screening and assessment of patients and their family's spiritual needs. Recognize when a referral to hospice is indicated. Manage the physical symptoms nearing the end of life (pain dyspnea, nausea, agitation, delirium, terminal secretions). Recognize palliative care's role the family and caregivers in post-death bereavement care. Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios.We look forward to speaking to you on our next episode of the MCG Pediatric Podcast.     References:                                                                Bergstraesser, E. (2013). Pediatric palliative care—when quality of life becomes the main focus of treatment. European journal of pediatrics, 172(2), 139-150. Ferrell BR, Twaddle ML, Melnick A, Meier DE. National Consensus Project Clinical Practice Guidelines for Quality Palliative Care Guidelines, 4th Edition. J Palliat Med. 2018 Dec;21(12):1684-1689. doi: 10.1089/jpm.2018.0431. Epub 2018 Sep 4. PMID: 30179523. Hsiao, J. L., Evan, E. E., & Zeltzer, L. K. (2007). Parent and child perspectives on physician communication in pediatric palliative care. Palliative & Supportive Care, 5(4), 355. Jones, B. L., Contro, N., & Koch, K. D. (2014). The duty of the physician to care for the family in pediatric palliative care: context, communication, and caring. Pediatrics, 133(Supplement 1), S8-S15. Linebarger, J., & Moreno, M. A. (2019). Pediatric palliative care. JAMA pediatrics, 173(11), 1115-1115.

Palliative Care with Dr. Sharon Beall Participants: Rachel Vaizer, MD Sharon Beall, MD Zachary Hodges, MD Peer review by the MCG Pediatric Podcast Committee Free CME Credit:  Click Here About our guest: Dr. Sharon Beall is an Associate Professor of Pediatrics at the Medical College of Georgia and the medical director for the Children's Hospital of Georgia palliative care and hospice program. Learning Objectives: After listening to this podcast, learners should be able to: Understand the value of palliative care as well as an overview of palliative care principles and practices. Recognize the need for expertise in the assessment and treatment of patient symptom burden, functional status and quality of life. Recognize the burden of serious illness and the role of palliative care in screening, assessing and treating psychological and psychiatric illnesses. Recognize the social limitations in caring for the seriously ill and have a guide for screening for access to social support, food, housing, transportation and adaptive equipment. Recognize the importance of spiritual and cultural beliefs in patient and family decision making. Understand the importance of screening and assessment of patients and their family's spiritual needs. Recognize when a referral to hospice is indicated. Manage the physical symptoms nearing the end of life (pain dyspnea, nausea, agitation, delirium, terminal secretions). Recognize palliative care's role the family and caregivers in post-death bereavement care. Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios.We look forward to speaking to you on our next episode of the MCG Pediatric Podcast.     References:                                                                Bergstraesser, E. (2013). Pediatric palliative care—when quality of life becomes the main focus of treatment. European journal of pediatrics, 172(2), 139-150. Ferrell BR, Twaddle ML, Melnick A, Meier DE. National Consensus Project Clinical Practice Guidelines for Quality Palliative Care Guidelines, 4th Edition. J Palliat Med. 2018 Dec;21(12):1684-1689. doi: 10.1089/jpm.2018.0431. Epub 2018 Sep 4. PMID: 30179523. Hsiao, J. L., Evan, E. E., & Zeltzer, L. K. (2007). Parent and child perspectives on physician communication in pediatric palliative care. Palliative & Supportive Care, 5(4), 355. Jones, B. L., Contro, N., & Koch, K. D. (2014). The duty of the physician to care for the family in pediatric palliative care: context, communication, and caring. Pediatrics, 133(Supplement 1), S8-S15. Linebarger, J., & Moreno, M. A. (2019). Pediatric palliative care. JAMA pediatrics, 173(11), 1115-1115.

Hosts: Medical Student: Brooke Pace Quertermous Faculty: Katie McKie, MD Faculty: Ryan Harris, Ph.D Peer Review: Rebecca Yang, MD; Janelle McGill, MD During this episode, you will learn that Cystic Fibrosis is more than just a lung disease. Individuals with CF are also at risk for malabsorption, maldigestion, intestinal obstruction, exercise intolerance, and other systemic abnormalities. Dr. Katie McKie, Director of Pediatric Pulmonology at Augusta University, joins Dr. Ryan Harris, Founder and Director of the LIVEP and CF researcher, and Medical Student Brooke Quertermous to discuss the impact of nutrition and exercise on children with CF. Specifically, they will:  Explain the mechanism by which CF affects digestion and absorption of nutrients Acknowledge the importance of frequent growth monitoring for children with CF. Understand the role of nutrient supplementation for children with CF, and when enteral nutrition is required. Describe why exercise intolerance occurs in CF and the necessity of regular exercise for these patients. FREE CME Credit (requires sign-in): https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=8631 Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenariosWe look forward to speaking to you on our next episode of the MCG Pediatric Podcast.   References: Gajbhiye, R., et al., Cystic fibrosis transmembrane conductance regulator (CFTR) gene abnormalities in Indian males with congenital bilateral absence of vas deferens & renal anomalies. Indian J Med Res, 2016. 143(5): p. 616-23. AND Elborn, J.S., Cystic fibrosis. Lancet, 2016. 388(10059): p. 2519-2531.) (Kuk, K. and J.L. Taylor-Cousar, Lumacaftor and ivacaftor in the management of patients with cystic fibrosis: current evidence and future prospects. Ther Adv Respir Dis, 2015. 9(6): p. 313-26.) (Farrell et al, Siret el al, Sims et al). Sullivan, J. S., & Mascarenhas, M. R. (2017). Nutrition: Prevention and management of nutritional failure in cystic fibrosis. Journal of Cystic Fibrosis, 16. doi:10.1016/j.jcf.2017.07.010 Committee On Practice And Ambulatory Medicine, & Workgroup, B. (2020, March 01). 2020 recommendations for Preventive Pediatric health care. Retrieved March 22, 2021, from https://pediatrics.aappublications.org/content/145/3/e20200013 Cystic Fibrosis Foundation, et al. Cystic Fibrosis Foundation evidence-based guidelines for management of infants with cystic fibrosis, J Pediatr 2009; 155(6 Suppl):S73-93.) (Nutrition Prevention and Management Article) (Mattar AC, Leone C, Rodrigues JC, Adde FV. Sweat conductivity: an accurate diagnostic test for cystic fibrosis? J Cyst Fibros. 2014 Sep;13(5):528-33. doi: 10.1016/j.jcf.2014.01.002. Epub 2014 Jan 31. PMID: 24485874.) Ameet Daftary, James Acton, James Heubi, Raouf Amin, Fecal elastase-1: Utility in pancreatic function in cystic fibrosis, Journal of Cystic Fibrosis, Volume 5, Issue 2, 2006, Pages 71-76,ISSN 1569-1993, Walkowiak, D. Sands, A. Nowakowska, R. Piotrowski, K. Zybert, K.H. Herzig, et al. Early decline of pancreatic function in cystic fibrosis patients with class 1 or 2 CFTR mutations J Pediatr Gastroenterol Nutr, 40 (2) (2005), pp. 199-201 Witt, H. (2003). Chronic pancreatitis and cystic fibrosis. Gut, 52(90002), 31ii-41. doi:10.1136/gut.52.suppl_2.ii31 Fielding, J., Brantley, L., Seigler, N., McKie, K. T., Davison, G. W., & Harris, R. A. (2015). Oxygen uptake kinetics and exercise capacity in children with cystic fibrosis. Pediatric Pulmonology, 50(7), 647-654. doi:10.1002/ppul.23189 Orenstein, D. (2018). The Relationship between CFTR Genotype and Exercise Tolerance in Cystic Fibrosis.. AnnalsATS, 15(2), 166. Marcotte JE, Canny GJ, Grisdale R, Desmond K, Corey M, Zinman R, Levison H, Coates AL. Effects of nutritional status on exercise performance in advanced cystic fibrosis. Chest. 1986 Sep;90(3):375-9. doi: 10.1378/chest.90.3.375. PMID: 3743150. Pastré, J., Prévotat, A., Tardif, C., Langlois, C., Duhamel, A., & Wallaert, B. (2014). Determinants of exercise capacity in cystic fibrosis patients with mild-to-moderate lung disease. BMC pulmonary medicine, 14(1), 1-8. Hulzebos, Erik H. J.1; Bomhof-Roordink, Hanna1,3; van de Weert-van Leeuwen, Pauline B.2; Twisk, Jos W. R.3; Arets, H. G. M.2; van der Ent, Cornelis K.2; Takken, Tim1 Prediction of Mortality in Adolescents with Cystic Fibrosis, Medicine & Science in Sports & Exercise: November 2014 - Volume 46 - Issue 11 - p 2047-2052 doi: 10.1249/MSS.0000000000000344 Ding S., Zhong C. (2020) Exercise and Cystic Fibrosis. In: Xiao J. (eds) Physical Exercise for Human Health. Advances in Experimental Medicine and Biology, vol 1228. Springer, Singapore. https://doi.org/10.1007/978-981-15-1792-1_26 Moorcroft AJ, Dodd ME, Morris J, Webb AK. Individualised unsupervised exercise training in adults with cystic fibrosis: a 1 year randomised controlled trial. Thorax. 2004 Dec;59(12):1074-80. doi: 10.1136/thx.2003.015313. PMID: 15563708; PMCID: PMC1746905. Pianosi P, Leblanc J, Almudevar A. Peak oxygen uptake and mortality in children with cystic fibrosis. Thorax. Jan 2005;60(1):50-54. LIVEP Contact: Reva Crandall at 706-721-5483.  

Join medical student Rilee Racine and Dr. Brian Stansfield, a neonatologist at the Children's Hospital of Georgia discuss Neonatal Opioid Withdrawal Syndrome, also known as NOWS.  After listening to this podcast, learners should be able to: Define neonatal opioid withdrawal syndrome Apply knowledge of signs and symptoms of NOWS to recognize these infants early Demonstrate general understanding of non-pharmacologic vs. pharmacologic management indications Recall the long term effects of NOWS and utilize this information to care for these infants long-term Educate families on clinical symptoms, management, and potential complications of NOWS Peer Review by Dr. Rebecca Yang and Dr. Amy Thompson Free CME Credit (requires sign-in): LINK COMING SOON Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu. Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. References: Anbalagan S, Mendez MD. Neonatal Abstinence Syndrome. 2020 Oct 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 31855342. Armbruster, Debra PhD, APRN-CNP, NNP-BC, CPNP-PC, C-ELBW; Schwirian, Caitlyn PharmD; Mosier, Ashley MS, RN, CNL; Tam, Wai-Yin Mandy PharmD, BCPS, BCCCP; Prusakov, Pavel PharmD, BCPS, BCPPS Neonatal Abstinence Syndrome and Preterm Infants, Advances in Neonatal Care: March 05, 2021 - Volume Publish Ahead of Print - Issue - doi: 10.1097/ANC.0000000000000858 Finnegan LP. Neonatal abstinence syndrome: assessment and pharmacotherapy. In: Nelson N, editor. Current therapy in neonatal-perinatal medicine. 2 ed. Ontario: BC Decker; 1990. Jansson, Lauren M. MD. Neonatal abstinence syndrome. Uptodate. (2020). Johnson MR, Nash DR, Laird MR, Kiley RC, Martinez MA. Development and implementation of a pharmacist-managed, neonatal and pediatric, opioid-weaning protocol. J Pediatr Pharmacol Ther. 2014 Jul;19(3):165-73. doi: 10.5863/1551-6776-19.3.165. PMID: 25309146; PMCID: PMC4187529. Maguire, Denise J, PhD,R.N., C.N.L., Taylor, Susan, MSW,L.C.S.W.-C., C.M.A., Armstrong, K., PhD., Shaffer-Hudkins, E., Germain, A. M., M.D., Brooks, Sandra S,M.D., M.P.H., . . . Clark, L. (2016). Long-term outcomes of infants with neonatal abstinence syndrome: NN. Neonatal Network, 35(5), 277-286. doi:http://dx.doi.org/10.1891/0730-0832.35.5.277 Mangat, A. K., Schmölzer, G. M., & Kraft, W. K. (2019). Pharmacological and non-pharmacological treatments for the Neonatal Abstinence Syndrome (NAS). Seminars in fetal & neonatal medicine, 24(2), 133–141. https://doi.org/10.1016/j.siny.2019.01.009 Merhar SL, Ounpraseuth S, Devlin LA, Poindexter BB, Young LW, Berkey SD, Crowley M, Czynski AJ, Kiefer AS, Whalen BL, Das A, Fuller JF, Higgins RD, Thombre V, Lester BM, Smith PB, Newman S, Sánchez PJ, Smith MC, Simon AE; EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT NEONATAL RESEARCH NETWORK AND THE NIH ENVIRONMENTAL INFLUENCES ON CHILD HEALTH OUTCOMES (ECHO) PROGRAM INSTITUTIONAL DEVELOPMENT AWARDS STATES PEDIATRIC CLINICAL TRIALS NETWORK. Phenobarbital and Clonidine as Secondary Medications for Neonatal Opioid Withdrawal Syndrome. Pediatrics. 2021 Mar;147(3):e2020017830. doi: 10.1542/peds.2020-017830. PMID: 33632932; PMCID: PMC7919109. Protecting Our Infants Act of 2015, H.R, 1462, 114th Cong. (2015-2016).  Sarka Lisonkova, Lindsay L. Richter, Joseph Ting, Giulia M. Muraca, Qi Wen, Azar Mehrabadi, Sheona Mitchell-Foster, Eugenia Oviedo-Joekes and Janet Lyons. Pediatrics August 2019, 144 (2) e20183664; DOI: https://doi.org/10.1542/peds.2018-3664 Siegler R., Saffran J., Eisenberg N., Deloache, J., & Gershoff, E. (2017). How Children Develop (5th ed.). NY, NY, USA: Macmillan Learning.  Stephen W. Patrick, Wanda D. Barfield, Brenda B. Poindexter and COMMITTEE ON FETUS AND NEWBORN, COMMITTEE ON SUBSTANCE USE AND PREVENTION. Neonatal Abstinence Withdrawal Syndrome. Pediatrics November 2020, 146 (5) e2020029074; DOI: https://doi.org/10.1542/peds.2020-029074 Patrick SW, Barfield WD, Poindexter BB; COMMITTEE ON FETUS AND NEWBORN, COMMITTEE ON SUBSTANCE USE AND PREVENTION. Neonatal Opioid Withdrawal Syndrome. Pediatrics. 2020 Nov;146(5):e2020029074. doi: 10.1542/peds.2020-029074. PMID: 33106341. Zimmermann, U., Rudin, C., Duò, A. et al. Treatment of opioid withdrawal in neonates with morphine, phenobarbital, or chlorpromazine: a randomized double-blind trial. Eur J Pediatr 179, 141–149 (2020). https://doi.org/10.1007/s00431-019-03486-6

Feedback with Dr. Lisa Leggio Participants Jameson Kenerly (MS4) Jessica Davis, DO Lisa Leggio, MD Zachary Hodges, MD Peer review by Dr. Andy Albritton and the MCG Pediatric Podcast Committee About our guest: Dr. Lisa Leggio is a professor of pediatrics here at the Medical College of Georgia and a practicing general pediatrician at the Children's Hospital of Georgia. She is the director of the pediatric clerkship which is commonly voted as a favorite rotation by our medical students. Individually, she is a very successful medical educator and has been recognized as the educator of the year multiple times here at our institution. Learning Objectives: After listening to this podcast, learners should be able to: Recognize and overcome barriers to giving feedback Recognize and overcome barriers to receiving feedback Describe and use 4 techniques for giving feedback FREE CME Credit (requires sign-in): https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=8420 Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenariosWe look forward to speaking to you on our next episode of the MCG Pediatric Podcast.   References: Armson H, Lockyer JM, Zetkulic M, Könings KD, Sargeant J. Identifying coaching skills to improve feedback use in postgraduate medical education. Med Educ. 2019 May;53(5):477-493. doi: 10.1111/medu.13818. Epub 2019 Feb 18. PMID: 30779210. Baldie D et al. Exploring the impact and use of patients' feedback about their care experiences in general practice settings – a realist synthesis.  Family Practice, 2018; 35(1):13-21. Boehler ML, Rogers DA, Schwind CJ, Mayforth R, Quin J, Williams RG, Dunnington G. An investigation of medical student reactions to feedback: a randomised controlled trial. Med Educ. 2006 Aug;40(8):746-9. doi: 10.1111/j.1365-2929.2006.02503.x. PMID: 16869919. Brown, B. (2018). Dare to lead: Brave work. Tough conversations. Whole hearts.New York: Random House. Dweck, C.S. (2008). Mindset: the New Psychology of Success.  New York:  Random House. Ende J. Feedback in clinical medical education. JAMA. 1983 Aug 12;250(6):777-81. PMID: 6876333. Fainstad T, Mcclintock A A, Van Der Ridder M J, et al. (December 11, 2018) Feedback Can Be Less Stressful: Medical Trainee Perceptions of Using the Prepare to ADAPT (Ask-Discuss-Ask-Plan Together) Framework . Cureus 10(12): e3718. doi:10.7759/cureus.3718 Gigante, J., Dell, M., & Sharkey, A. (2011). Getting beyond "Good job": how to give effective feedback. Pediatrics, 127(2), 205–207. https://doi.org/10.1542/peds.2010-3351 Sargeant J. Future Research in Feedback: How to Use Feedback and Coaching Conversations in a Way That Supports Development of the Individual as a Self-Directed Learner and Resilient Professional. Acad Med. 2019 Nov;94(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 58th Annual Research in Medical Education Sessions):S9-S10. doi: 10.1097/ACM.0000000000002911. PMID: 31365395. Stone, D. and Heen, S. (2014). Thanks for the Feedback: the Science and Art of Receiving Feedback Well* even when it is off base, unfair, poorly delivered, and, frankly, you're not in the mood. New York:  Penguin Books.

Juvenile Idiopathic Arthritis (JIA) Participants Christina Cho (MS3) Julisa Patel, MD Zachary Hodges, MD Peer review by pediatric rheumatologist Dr. Rita Jerath and the MCG Pediatric Podcast committee. About our guest: Dr. Julisa Patel is an Associate Professor of Pediatrics and practicing pediatric rheumatologist here at MCG.   Learning Objectives: By the end of listening to this episode, learners should be able to: Recognize the common signs and symptoms associated with juvenile idiopathic arthritis (JIA). Formulate a differential diagnosis for a child with arthritis. Understand the general diagnostic approach for a patient with likely JIA. Recognize the role but limitations of the laboratory evaluation for JIA. Initiate appropriate first-line therapy for JIA. Recall both the short- and long-term complications of JIA.   Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia.  If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu  Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. We look forward to speaking to you on our next episode of the MCG Pediatric Podcast.     Free CME Credit: https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=8419 References Shenoi S. Juvenile Idiopathic Arthritis - Changing Times, Changing Terms, Changing Treatments. Pediatr Rev. 2017 May;38(5):221-232. doi: 10.1542/pir.2016-0148. PMID: 28461613. Ringold S, Angeles-Han ST, Beukelman T, Lovell D, Cuello CA, Becker ML, Colbert RA, Feldman BM, Ferguson PJ, Gewanter H, Guzman J, Horonjeff J, Nigrovic PA, Ombrello MJ, Passo MH, Stoll ML, Rabinovich CE, Schneider R, Halyabar O, Hays K, Shah AA, Sullivan N, Szymanski AM, Turgunbaev M, Turner A, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis. Arthritis Care Res (Hoboken). 2019 Jun;71(6):717-734. doi: 10.1002/acr.23870. Epub 2019 Apr 25. PMID: 31021516; PMCID: PMC6561125.  

Trisomy 13 & 18—Family Perspective Wiley and Jenny Purcell Participants Wiley and Jenny Purcell Zachary Hodges All participants have no financial conflicts of interest to disclose. Peer review by Dr. Paul Mann and the MCG Pediatric Podcast Committee About our guests: Wiley and Jenny Purcell have been gracious to share their story of their son Samul and their family's experience with his diagnosis of trisomy 13. We are very excited to share their story! Learning Objectives: After listening to this podcast, learners should be able to better understand a family's experience with: A prenatal diagnosis of a life-limiting genetic disease A newborn baby requiring neonatal intensive care. Bringing a baby with complex medical needs home from the NICU. Daily life with an infant with special needs.   Links mentioned: SOFT—Support Organization for Trisomy; www.trisomy.org   String of Pearls: http://www.stringofpearlsonline.org/ Cuddle Cot: https://www.cuddlingangels.com/   Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. We look forward to speaking to you on our next episode of the MCG Pediatric Podcast.  

Trisomy 13 & 18—Family Perspective Wiley and Jenny Purcell Participants Wiley and Jenny Purcell Zachary Hodges All participants have no financial conflicts of interest to disclose. Peer review by Dr. Paul Mann and the MCG Pediatric Podcast Committee About our guests: Wiley and Jenny Purcell have been gracious to share their story of their son Samul and their family's experience with his diagnosis of trisomy 13. We are very excited to share their story! Learning Objectives: After listening to this podcast, learners should be able to better understand a family's experience with: A prenatal diagnosis of a life-limiting genetic disease A newborn baby requiring neonatal intensive care. Bringing a baby with complex medical needs home from the NICU. Daily life with an infant with special needs.   Links mentioned: SOFT—Support Organization for Trisomy; www.trisomy.org   String of Pearls: http://www.stringofpearlsonline.org/ Cuddle Cot: https://www.cuddlingangels.com/   Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. We look forward to speaking to you on our next episode of the MCG Pediatric Podcast.  

Trisomy 13 & 18 Cardiac Surgery with Dr. James St. Louis Participants: James St. Louis, MD Zachary Hodges, MD Peer review by Dr. Pushpa Shivaram and the MCG Pediatric Podcast Committee About our Guest: Dr. James St. Louis is the J. Harold Harrison, MD Distinguished Chair in Pediatrics, Surgery and Cardiothroacic Surgery at the Medical College of Georgia. He is the Chief of Pediatric Cardiothoracic and Congenital Cardiac Surgery at the Children's Hospital of Georgia.  Learning Objectives: After listening to this podcast, learners should be able to: Recognize the prevalence of congenital heart disease in children with Trisomy 13 & 18. Recall the limited access to cardiac surgery historically offered to children with Trisomy 13 & 18. Describe the general recent trends in pediatric cardiothoracic surgery for children with Trisomy 13 & 18, specifically increased access to surgical repair of relative low complexity lesions. Describe which cardiac abnormalities are increasingly being offered surgical repair by some centers. Recognize key factors or comorbidities that might guide the decision to offer or withhold corrective surgery for children with Trisomy 13 & 18. Generally, recognize which complex and multi-stage procedures are currently not being offered to children with Trisomy 13 & 18. Recognize the current variability of surgical options being offered between different centers. Describe what types of cardiac surgery are being offered to children with Trisomy 13 & 18 here at the Medical College of Georgia. Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. We look forward to speaking to you on our next episode of the MCG Pediatric Podcast.   Free CME Credit: https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=8278 References: McCaffrey MJ. Trisomy 13 and 18: Selecting the road previously not taken. Am J Med Genet C Semin Med Genet. 2016;172(3):251-256. doi:10.1002/ajmg.c.31512  Bajinting A, Munoz-Abraham AS, Osei H, Kirby AJ, Greenspon J, Villalona GA. To operate or not to operate? Assessing NSQIP surgical outcomes in trisomy 18 patients [published online ahead of print, 2020 Jun 5]. J Pediatr Surg. 2020;S0022-3468(20)30369-9. doi:10.1016/j.jpedsurg.2020.05.037  Neubauer K, Boss RD. Ethical considerations for cardiac surgical interventions in children with trisomy 13 and trisomy 18. Am J Med Genet C Semin Med Genet. 2020;184(1):187-191. doi:10.1002/ajmg.c.31767  Nelson KE, Rosella LC, Mahant S, Guttmann A. Survival and Surgical Interventions for Children With Trisomy 13 and 18 [published correction appears in JAMA. 2017 May 2;317(17 ):1803]. JAMA. 2016;316(4):420-428. doi:10.1001/jama.2016.9819 

Did you know that in the U.S., only 50% of infants are being exclusively breastfed at 3 months of age or that breastmilk helps reduce the incidence of otitis media and sudden infant death syndrome? Dr. Rebecca Pierce, a general pediatrician and international board certified lactation consultant at the Children's Hospital of Georgia is joined by pediatric resident Nicole Lock to discuss the importance of breastfeeding. Specifically, they will: Review guidelines and recommendations for breastfeeding Discuss breastfeeding benefits and contraindications Recognize common problems in breastfeeding and discuss practical solutions Discuss barriers to breastfeeding Review appropriate resources for breastfeeding mothers and providers Highlight current research on antibodies in breastmilk after Covid-19 vaccination or infection Special thanks to Dr. Kathryn Mcleod, Dr. Amy Thompson, and Dr. Rebecca Yang for peer reviewing this episode. For Show Notes:  Follow the linkhttps://www.augusta.edu/mcg/pediatrics/residency/podcast-episodes.php Free CME Credit: https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=8277 References: Breastfeeding and the Use of Human Milk. SECTION ON BREASTFEEDING. Pediatrics Mar 2012, 129 (3) e827-e841; DOI: 10.1542/peds.2011-3552 La Leche League International, https://www.llli.org/breastfeeding-info/ Your Guide to Breastfeeding. Office on Women's Health, US Department of Health and Human Services. https://www.womenshealth.gov/files/your-guide-to-breastfeeding.pdf Mitchell EA, Blair PS, L'Hoir MP. Should pacifiers be recommended to prevent sudden infant death syndrome? Pediatrics. 2006 May;117(5):1755-8. doi: 10.1542/peds.2005-1625. PMID: 16651334. Perl et al. SARS-CoV-2–Specific Antibodies in Breast Milk After COVID-19 Vaccination of Breastfeeding Women. JAMA. April 2021. Wymore et al, Persistence of Δ-9-Tetrahydrocannabinol in Human Breast Milk. JAMA Pediatrics, March 2021; DOI: 10.1001/jamapediatrics.2020.6098  

Trisomy 13 & 18 Ethical Considerations with Dr. Paul Mann PARTICIPANTS: Paul Mann, MD Zachary Hodges, MD About Our Guest: Dr. Paul Mann is an Associate Professor of Pediatrics, Chief of the Division of Neonatology and practicing neonatologist at the Medical College of Georgia. He also is the Director of Clinical Ethics for the Augusta University Center for Bioethics and Health Policy. Free CME Credit: https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=7772 Learning Objectives: By the end of listening to this episode, learners should be able to: Recognize aneuploidies as a common cause of genetic abnormalities in pregnancy. Recognize the historically pessimistic counseling given to families of children with trisomy 13 and 18 and how this might continue to influence our counseling today. Recall how most babies are prenatally diagnosed with trisomy 13 and 18. Describe the life-limiting malformations associated with trisomy 13 and 18. Recognize the recent improvement in prognosis of children with trisomy 13 and 18 as they are being selectively offered more intensive and surgical care. Sensitively counsel families about the general prognosis of newborns with trisomy 13 and 18 while avoiding inaccurate and problematic language such as “lethal and incompatible with life.”        Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu. Remember that all content during this episode is intended for informational and educational purposes only. It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. We look forward to speaking to you on our next episode of the MCG Pediatric Podcast.     Peer Reviewers: Amy Thompson, MD & MCG Pediatric Podcast Committee   References: Kett JC. Who Is the Next "Baby Doe?" From Trisomy 21 to Trisomy 13 and 18 and Beyond. Pediatrics. 2020;146(Suppl 1):S9-S12. doi:10.1542/peds.2020-0818D American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics; Committee on Genetics; Society for Maternal–Fetal Medicine. Practice Bulletin No. 162: Prenatal Diagnostic Testing for Genetic Disorders. Obstet Gynecol. 2016;127(5):e108-e122. doi:10.1097/AOG.0000000000001405 Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs. Stamford, Conn: Appleton & Lange, 1999. Print. McCaffrey MJ. Trisomy 13 and 18: Selecting the road previously not taken. Am J Med Genet C Semin Med Genet. 2016;172(3):251-256. doi:10.1002/ajmg.c.31512 Bajinting A, Munoz-Abraham AS, Osei H, Kirby AJ, Greenspon J, Villalona GA. To operate or not to operate? Assessing NSQIP surgical outcomes in trisomy 18 patients [published online ahead of print, 2020 Jun 5]. J Pediatr Surg. 2020;S0022-3468(20)30369-9. doi:10.1016/j.jpedsurg.2020.05.037 Neubauer K, Boss RD. Ethical considerations for cardiac surgical interventions in children with trisomy 13 and trisomy 18. Am J Med Genet C Semin Med Genet. 2020;184(1):187-191. doi:10.1002/ajmg.c.31767 Wightman A, Kett J, Campelia G, Wilfond BS. The Relational Potential Standard: Rethinking the Ethical Justification for Life-Sustaining Treatment for Children with Profound Cognitive Disabilities. Hastings Cent Rep. 2019;49(3):18-25. doi:10.1002/hast.1003 Nelson KE, Rosella LC, Mahant S, Guttmann A. Survival and Surgical Interventions for Children With Trisomy 13 and 18 [published correction appears in JAMA. 2017 May 2;317(17 ):1803]. JAMA. 2016;316(4):420-428. doi:10.1001/jama.2016.9819